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
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
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widows, is withdrawn.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
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
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
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
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
Nightingale improves conditions
Nurse Florence Nightingale and volunteer nurses
are sent to Turkey during the Crimean War to oversee the
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.