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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.


English Civil War breaks out

With the outbreak of civil war, Parliament recognizes 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 recognizes 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 Savoy Hospital, London. Two additional military hospitals open in London during the Civil War and the succeeding period of parliamentary and military rule (Interregnum). Nurses are recruited from among the widows of soldiers. The first military hospital regulations are enacted.


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 Portsmouth and East Anglia. During the conflict about 2,500 Englishmen are killed.


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King now in power, funding for the hospitals, which had served the soldiers of Parliament's army and their widows, is withdrawn.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.


First field hospitals established

Mobile field hospitals (hospitals on the battlefield) are established by William III during the Nine Years' War.

In addition to static hospitals, William III establishes the English Army's first mobile field hospitals. These mobile medical units situated on the battlefield are introduced during the Nine Years' War of the 1690s in Ireland and Flanders. For the first time, a mobile hospital can work close to a battle, providing quick treatment for sick and wounded soldiers. Before mobile hospitals, patients had to endure a long and painful journey to a base hospital. This process contributed significantly to a battle's death toll. The first physician general, surgeon general and apothecary general positions are also created, which leads to improvements in the organization and delivery of military healthcare.


Flying hospitals on battlefields

Flying hospitals accompany the Duke of Marlborough's armies to war and are used to treat and transport casualties.

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 Flanders, via static hospitals, to England. They are comparable with present-day field ambulances.


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 recognizes hospitals as among the chief causes of sickness and death in the Army.


First permanent military hospital

The first permanent hospital for the Standing Army is established by leading surgeon John Hunter in Chelsea.

John Hunter is appointed surgeon general having held the deputy role since 1786. He's a leading anatomist and one of the first to recognize how scientific experiments can benefit medicine. He establishes the York Hospital in Chelsea as the Standing Army's first permanent hospital. This hospital is the Army's main receiving hospital for casualties evacuated from overseas throughout the Revolutionary and Napoleonic Wars. He dies in October 1793 as the result of a heart attack during an argument over the admission of students.


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.


Navy first to use anesthetic

The first recorded use of anesthetic in the services is in the Navy for a dental extraction by Thomas Spencer Wells.

The first recorded anesthetic 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 anesthesia 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.


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 Eastern Europe.

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 Britain relatively quickly. The Crimean War is the first major conflict in which anesthesia is used extensively on the battlefield. Chloroform is almost always the anesthetic used.


Nightingale improves conditions

Nurse Florence Nightingale and volunteer nurses are sent to Turkey during the Crimean War to oversee the military hospital.

Florence Nightingale and a staff of 38 volunteer nurses, trained by her, are sent to Scutari in Turkey to oversee the nursing at the military hospital. She finds medicines in short supply, hygiene neglected and mass infections common, many of them fatal. Her presence leads to a dramatic improvement in conditions within the hospital, where the majority of soldiers were dying from disease. In 1890 there was a public outcry when it was found that many veterans at the 1854 Battle of Balaklava were poverty-stricken. A fund was set up and on 30 July 1890 Florence Nightingale recorded a speech to raise money.


Major military healthcare reforms

The Crimean War prompts Florence Nightingale to call for a Royal Commission into military hospitals. Important healthcare reforms follow.

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 Nightingale Training School, at St Thomas' Hospital in London.


Royal Victoria Hospital opens

The Royal Victoria Hospital is the first purpose-built military hospital and appoints its first professor of military hygiene.

The Royal Victoria Hospital at Netley in Hampshire is the first of Britain's purpose-built military hospitals to open. It is also the new home of the Army Medical School. Edmund Alexander Parkes is the school's first professor of military hygiene. His research leads to significant improvements in the health of soldiers, which earns him the reputation as the founder of modern military hygiene.


Nursing service established

Nursing staff are organized in the first major step towards a regular, uniformed nursing service for the Army.

Nursing personnel are organized 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.


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 typhus. 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.


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.


New medical corps set up

The creation of the Royal Army Medical Corps leads to improved efficiency as a single organization 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.


Re-organization 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-organization of nursing services and the formation of the Queen Alexandra's Imperial Military Nursing Service (QAIMNS). This is accompanied by a sister organization, 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).


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.


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 defense medical services.


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 mechanization 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.

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 vapor, 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.


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 orthopedics, 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.


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, specializing 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 industrialized 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.

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.

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.


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.


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.


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.

Fatalities from disease drop

Immunization programs and the widespread availability of antibiotics are significant in the fight against disease among Allied Forces.

Immunization programs 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.


Motorized ambulances used

Evacuation of casualties improves with the widespread use of ambulances and airplanes.

Most casualties are receiving treatment within hours of being injured due to the increased mobility of field hospitals and the extensive use of motorized ambulances. Airplanes are also used as ambulances to evacuate the most serious casualties.


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 Defense Medical Rehabilitation Centre (DMRC), offering treatment for injured service personnel from across the armed forces.


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-organization of nursing services means QARANC becomes a distinct corps within the regular and territorial armies.


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 airplane is also in operation.


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.


PTSD recognized for first time

American psychiatrists recognize post-traumatic stress disorder (PTSD) as a diagnosable psychiatric disorder.

American psychiatrists recognize 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 recognized and described by terms such as shell shock and battle fatigue.


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