War and the Militarization of British Army Medicine, 1793-1830

Catherine Kelly

• Publisher: Routledge
• Year: 2015
• Print ISBN:
  9781848931831
• Edition: 1
• eBook ISBN:
  9781317322443
• Topic: History
• Subtopic: World History
• Index: History

This study demonstrates the emergence and development of the identity of the 'military medical officer' and places their work within the broader context of changes to British medicine during the first half of the nineteenth century.

1
The Low Countries and the West Indies

Sir John Fortescue described the work of the British army in the first ten years of the Wars as ‘vast … thankless … and unprofitable’.¹ His assessment might well have been shared by many of the medical officers who laboured during those years in difficult and disease-ridden environments, overseeing the deaths of large numbers of soldiers, for little apparent strategic gain. The West Indian expeditions of the years 1793–8 have, in particular, attracted the attention of historians for their appalling death rates among British troops.² These expeditions have also been identified by historians of medicine as an important contributor to the development of a distinct empirical and experimental approach to medicine particular to the tropics,³ and to the reform of the AMD.⁴ In contrast, the other major British military undertaking of the period, the Duke of York’s campaigns in the Low Countries during the years 1793–5, has been largely ignored by historians both military and medical.⁵ However, the campaigns in the Low Countries were fundamental to the ways in which British military medicine, and the self-image of British army medical officers, developed over the course of the Wars.

The campaigns in the Low Countries began in February 1793 when France declared war on Britain and Holland. Britain responded by entering an alliance with Austria and Prussia to protect the neutrality of Holland and to maintain the free access of shipping in the Scheldt. A meagre force of 2,500 British men was embarked under the leadership of Frederick Augustus, Duke of York. Those men joined a force of 100,000 Dutch and Austrian soldiers and British-funded Hessian and Hanoverian mercenaries. The allied army achieved some success against the French in 1793, but in 1794 (despite an influx of recruits) both the British and Austrian forces suffered a series of defeats. Towards the end of the year, the British forces carried out their retreat, ill provisioned and practically naked, in appalling winter conditions with dramatically rising numbers of sick troops. This desperate state of affairs continued throughout the first few months of 1795, until on 8 March the British Cabinet decided to withdraw from the Continent.

What little historical attention the campaigns of 1793–5 have received has not been very positive. Cantlie concluded that ‘the campaign ended in disaster to the British Army, and a disaster for the Medical Department’.⁶ Fortescue made serious criticisms of many aspects of the campaign but left his most damning for the medical arrangements, stating that, ‘the very worst department of them all was that of the hospitals, wherein the abuses were so terrible that men hardly liked to speak of them’; and that the department comprised a ‘medical staff … improvised out of drunken apothecaries, broken down practitioners, and rogues of every description, who were provided under some cheap contract’.⁷

Fortescue’s condemnation appears to have been based on opinions expressed by several military officers in letters written during the campaign. As will be seen, his conclusion is not supported by the evidence. However, it remains that contemporaries perceived the medical services provided during this campaign to have been woefully inadequate. Sickness rates were high, particularly in the latter stages of the campaign when troops suffered principally from a contagious fever.⁸ As mortality rates in the general hospitals appeared to rise inexorably, tensions within the medical department grew.⁹ The resulting infighting of the medical staffwas considered unforgivable by military officers who blamed it for the rising death rate. However, as Cantlie noted, many of the medical department’s failings were actually the fault of poor logistical planning by military leaders and unworkable policies enforced by the AMB. Many medical men who were to become influential later in the Wars, including James McGrigor, William Fergusson and Robert Jackson, served on these campaigns, and the lessons they took from the chaos on the Continent were to have a profound impact on the development of military medicine.

This chapter will consider the numerous conflicts over the control of the medical arrangements of the army that were entered into during the Low Countries campaigns. It will demonstrate that by the end of these campaigns two important trends had begun to emerge in British army medicine: an attempt to articulate a distinct military medical specialty; and a struggle by medical practitioners to adapt to a military framework, alongside attempts to manipulate it to obtain medical power. The chapter will go on to examine how those trends, which became dominant features of the army medical culture for the rest of the Wars, were reinforced by innovations in medical theory and were enhanced when the medical practitioners who had served in the Low Countries encountered the particular disease environment of the West Indies.

Military versus Civilian Practitioners

At the commencement of hostilities, the AMD was headed by the physician general, Sir Clifton Winteringham and the surgeon general, John Hunter.¹⁰ Owing to Winteringham’s advanced age and incapacity, in practice Hunter ran the AMD. Following Hunter’s death in October 1793 a new AMB was appointed, comprising Surgeon General Mr John Gunning; Inspector General Thomas Keate; and (following the death of Winteringham in January 1794) Physician General Sir Lucas Pepys.¹¹

The failings of the medical department in the Low Countries can be attributed to a multitude of factors, including the constantly changing military command of the general hospitals and the logistical difficulties of providing medical care throughout a continuous retreat. But the greatest contributing factor to the failures of the medical staff was the decision of the new AMB to appoint civilian physicians (that is, physicians who had not been brought up through the AMD) to run the general hospitals.¹² This practice was particularly aggravating to military surgeons because it was the reverse of Hunter’s policy which had applied when many of them had joined the army, and only came into force after the campaign was already underway.

At the start of the campaign, Hunter had written to the commander-in-chief, Lord Jeffrey Amherst, setting out his policy on the selection and promotion of medical officers which required that surgeons should serve a sort of apprenticeship in the medical service of the army and work their way up through the ranks:

When I had the Honour of my present Appointment I wished very much there should be some system of promotion … which was that Gentlemen of that profession should begin with Mateships of regiments, that they should be promoted to Hospital Mateships; from Hospital mate to be Regimental Surgeons; from Regimental Surgeons to the Staff, either as Surgeons, or Apothecaries, and from that Station on the Staff to be Physicians, Purveyors, &c … I have never once allowed my Friendship for any one to make me break through that rule, nor have I allowed the Solicitation of my best Friends, much my superiors, to make me recede from it.

Very importantly, Hunter went on to state that application of that policy had positively affected recruitment into the army and established clear career expectations for the army surgeon:

Since the above plan has been adopted, and most religiously executed on my part, the Physical Gentlemen of the Army have looked up to me as their protector, and I am certain many have entered as mates of Regiments upon the Faith of regular promotion that would not otherwise have entered and I could wish to keep their Confidence with me.¹³

Following Hunter’s death, those expectations were dealt a devastating blow. Shortly after their appointment, Keate wrote to Gunning criticizing the system of promotion, suggesting that it favoured ‘old Regimental Surgeons’ who should more properly decorate the superannuated list.¹⁴ The AMB members devised a new plan which they described as ‘the reverse of our predecessor … to make Physicians of Gentlemen bred to Physick, and Hospital Surgeons of Men bred to Surgery’.¹⁵

The new approach of the AMB set ‘civilian’ and ‘military’ medical men in the army against each other, as it considered ‘Gentlemen bred to Physick’ to be civilian practitioners who held a degree in medicine from a select group of universities, effectively debarring military surgeons from promotion. This caused military practitioners at all levels to consider their qualifications and assert their various claims to professional competence in ways they had not been required to do in the past.

The AMB’s attitude to the regimental surgeon was hardly novel. The shortcomings of regimental surgeons had become a point of comment in medical literature, and in the correspondence of the AMB before this time.¹⁶ The general complaint against the regimental surgeon’s education was put forward by Dr Robert Hamilton in his Duties of a Regimental Surgeon published in 1794. He argued that although some had received a ‘proper’ medical education at a university ‘many more have … find [sic] their way into it thro’ interest and mis-applied recommendation’,¹⁷ and that others had been admitted who were merely ‘boys who have served in the shop of some country apothecary only a year or two, nay it may be only a few months’.¹⁸ His further objection related to the inadequacy of their training whilst serving with the army. Hamilton believed a university education was necessary to absorb and understand what the young surgeon saw on service.¹⁹

The new AMB was not entirely hostile to regimental surgeons. In fact, the AMB was zealous in protecting their financial interests through promotion to non-medically active positions such as apothecaryships and purveyorships as a reward for long service.²⁰ Many older regimental surgeons may have been content with that arrangement; however, for the young men recently entered into the medical service, and those who were to follow them, the denigration of the regimental surgeon’s abilities was devastating. What was most significant, to the men of the medical service, was the clear statement that previous lines of promotion would be denied them, and those men not ‘bred to physick’ could not ever expect to become military physicians. This attitude was in direct contrast to the writings of leading military practitioners who had previously acknowledged the blurring of boundaries between physic and surgery in military practice. Even Hamilton had said,

we all know that regimental practice partakes more of the physician’s than the surgeon’s province … we oftener meet with fever, and other contagious and epidemic diseases among soldiers, than such only as need external treatment, and the hand of the operative surgeon.²¹

The policy also impeded recruitment, causing surprise to many practitioners eager to enlist as the Wars continued. The AMB records are full of letters to various doctors and surgeons informing them that without the degree of MD from a ‘respectable’ university or taking the examination for Licentiate of the Royal College of Physicians, they could not be appointed to the army in the position they sought.²²

As will be seen later in this chapter, the policy was one which the AMB was constantly called on to defend to military leaders, and which it took the step of explaining in detail to the King.²³ Ultimately, the AMB defended its position by arguing that surely military commanders would want, ‘Army Physicians legally authorized to practice Physic in England’ – a misrepresentation of actual legal requirements to practise medicine in England.²⁴ The policy was also roundly criticized by several medical practitioners after the campaign. The earliest of these tracts was written in 1796 by Nathanial Sinnott who had served with the army in the Low Countries. Despite acknowledging that the circumstances were ‘unfavourable … to the forming of a perfect hospital’, Sinnot argues that the accumulated miseries suffered by the unfortunate soldiers could only have come about as a result of ignorance, mismanagement or neglect. That ignorance, especially of military medical practice, he laid at the door of the hospital staff chosen by the AMB:

Medical skill, activity and a knowledge of the oeconomy and regulation of military hospitals, constitute the chief qualifications of an army physician; and the last is more necessary, and of more consequence, than profound medical erudition. The miseries experienced by the sick did not proceed so much from a want of medical knowledge, as from a want of skill and activity in the management of our hospitals …

The Medical Board therefore, in appointing physicians to the Army, have not been sufficiently attentive to their necessary qualifications, for they have not recommended such as could possibly know any thing of military hospitals previous to their being appointed. A man directly from a university, without experience, even in physic, may be appointed physician to the army, if he become a licentiate of the College of Physicians; this is the only preparation thought necessary, and so rigidly do they adhere to this system, that if a man possessed the knowledge of Sir John Pringle, it would not recommend him so much as having a licence from the College.²⁵

Dr James Borland also wrote about the impressions he had formed after the first embarkation of troops for the Continent. He had thought twice about presenting his observations to the AMB immediately following the campaign, but by 1805 had b...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• Acknowledgements
• Abbreviations
• Note on the Text
• Introduction
• 1 The Low Countries and the West Indies
• 2 Walcheren and the Army Medical Board
• 3 Egypt, Ophthalmia and Plague
• 4 The Peninsular War
• 5 James McGrigor in the Peninsula
• 6 Beyond the Wars
• Conclusion
• Notes
• Works Cited
• Index