To war in an ambulance

As part of my background work for the novel I am currently writing I have been researching the Royal Army Medical Corps (RAMC) which has proved to be a fascinating subject. Their Corps Day is 23rd June so it seemed appropriate that my article this month should be about these brave men and women who serve our soldiers in so many different ways.

The Royal Army Medical Corps (affectionately known as the ‘Linseed Lancers’) serve both at home and wherever in the world the British Army is on deployment as they are responsible for ensuring that servicemen and women, and their families, are fit and healthy. Members of the Corps not only provide emergency care on the front line or during humanitarian operations (such as after earthquakes or hurricanes) but are also responsible for providing routine treatment or long term care for soldiers as well as instituting health programmes and preventing disease.

The RAMC is non-combatant and subject to the Geneva Conventions. As such Corps members do not take part in attacks and are only allowed to use their weapons for self-defence. This has led to two traditions which make the RAMC stand out when on parade; firstly, officers do not draw their swords but salute with the right hand whilst holding their scabbard in their left; secondly, other ranks do not carry weapons when on parade. The Corps is also identifiable by its insignia which shows the Rod of Asclepius (a rod with a serpent entwined round it which was carried by Asclepius, the Greek god of healing and medicine), above the rod is a crown, and below it the Regimental motto In Arduis Fidelis (Faithful in Adversity).

The Royal Army Medical Corps was formed by Royal Warrant on 23rd June 1898 (120 years ago today) but the history of army medical services goes back much further than that.

A Standing Regular Army was only formed in Britain after the Restoration of Charles II in 1660, and it was at that time that each infantry and cavalry regiment was assigned a Regimental Surgeon with a Warrant Officer as his Assistant. Although this was a step forward in the treatment of soldiers the Duke of Marlborough wanted to give even better care to his wounded men and so set up ‘Marching Hospitals’ to accompany his armies during the reign of Queen Anne (1702-1714), but it was not until the Peninsular Wars against Napoleon (1808-1814) that the army medical services were organised on a more formal basis.

James McGrigor

During the Napoleonic Wars Sir James McGrigor made changes to the army medical services in an attempt to make them more efficient, he continued that work following the Battle of Waterloo in 1815. Thanks to Sir James a system of casualty evacuation was set up which included the setting up of pre-fabricated huts to treat the wounded, and McGrigor’s system of registering casualties is still the basis of the recording of medical statistics today. McGrigor also set up the Benevolent Fund and the Widows and Orphans Fund to care for soldiers and their families.

Britain was at peace for almost forty years after the Battle of Waterloo and, unfortunately, during that time many of the lessons of the Napoleonic Wars were forgotten. When the Crimean War began in 1854 civilian departments were given responsibility for medical support and often met to make plans without consulting with anyone from the army. Needless to say, the results were disastrous. At this time a medical officer would be commissioned and wear the uniform of the Regiment he was assigned to but held no rank and so was under the command of his Colonel. The medical officer had no trained staff to help him treat the wounded, just a few men from the Regiment who he would try to give basic first aid training to. The lack of care meant that many soldiers died from wounds and disease who could have recovered under a better system. The telegraph (developed in the 1830’s and 40’s) meant that people back in Britain soon learned of the inadequate care being given to our troops abroad and the scandal caused a national outcry which led to Sir Andrew Smith, (the Director General of the Medical Services) urging the War Office to set up a proper medical corps. The response of the politicians? To create and send to the Crimea an ambulance force made up of 300 old army pensioners. Smith said that they could hardly carry themselves and would not be able to care for the sick and wounded. Smith’s prediction was proved true as the new corps was depleted by deaths from cholera with many of those surviving turning to alcohol. Smith finally saw progress when the Medical Staff Corps was formed in 1855, the instruction was that it should be made up of ‘Men able to read and write, of regular steady habits and good temper and of a kindly disposition’.

A tinted lithograph by William Simpson illustrating conditions of the sick and injured in Balaklava

The Medical Service continued to evolve, and by 1873 doctors who wanted to sign up needed to be qualified, single, and at least 21 years old; they also had to pass exams in physiology, surgery, medicine, zoology, botany, and physical geography including meteorology, as well as reaching a number of other standards including having been present at 12 births and having dissected the whole body at least once. Despite the changes, well qualified army doctors still did not hold military rank which often left them feeling excluded from decision making, they also had to serve longer in India than other members of the British Army (6 years at a time) and received less pay when serving there. Many members of the service felt that their treatment was discriminatory and they needed to have an identity of their own which would give them some kind of parity in service and in the awarding of honours. Finally, the two distinct parts of the Army Medical Services – the Medical Staff Corps (ordinary ranks) and the Medical Staff (officers) – were reorganised into the Roya Army Medical Corps by Royal Warrant on 23rd June 1898; officers were now given executive and administrative powers and the Corps was soon serving in the Sudan, and in South Africa during the Boer War when the Corps lost 743 officers and 6,130 soldiers in other ranks.

Stretcher-bearers of the Indian Ambulance Corps during the Boer War, including the future leader Mohandas Karamchand Gandhi (Middle row, 5th from left).
Alfred Fripp

Many of the soldiers in South Africa were treated by civilian doctors who volunteered their support; their hospitals were much more efficient than those of the RAMC and, at the end of the war, some of those volunteers campaigned for the radical reform of the Corps. Alfred Fripp was key to this as he was friends with the new king, Edward VII, who made sure that the army paid proper attention to Fripp’s ideas. Fripp, and his colleague Cooper Perry, were instrumental in setting up the Hospital and Medical School at Millbank, London; in 1903 both were knighted for their services to the RAMC Committee of Reform. During the Boer War the medical services had treated 22,000 wounded soldiers yet spent far more time and resources on the 74,000 who suffered dysentery or typhoid fever. It became clear that the Corps needed to focus on preventing disease as well as treating the wounded, and by the outbreak of the First World War an anti-typhoid vaccine had been developed which had such an impact that a disease which had killed 8,000 in South Africa had a negligible effect in the trenches of Northern Europe.

Alfred Keogh

Sir Alfred Keogh (who had worked with Fripp and Perry on the RAMC Committee of Reform) was made Director General of the RAMC from 1904 -1910 and worked hard to ensure that the medical services were seen not as something separate from but as an essential part of the British Army. Keogh was again made Director General of the Corps (1914 -18) and presided over its rapid expansion. At the outbreak of war there were approximately 9,000 members of the ranks, at the end of the war there were around 154,000 as well as 13,000 RAMC Officers in service in all theatres of the war. Thanks to Keogh’s planning a chain of evacuation was set up to move the wounded back down the line through a series of posts, which streamlined and speeded up the care which could be given to wounded soldiers. A patient would typically go through the following posts:

 

Regimental Aid Post
Collecting Post
Advanced Dressing Station
Main Dressing Station
Casualty Clearing Station (some could take up to 1,000 patients at a time)
Hospital (either in France or England)

Please click here to see a remarkable video showing the work of the RAMC during the First World War. The film is held by the Imperial War Museum.

By the Second World War the RAMC was much more mobile and able to work more effectively on the front line, there were also developments such as the use of penicillin and blood transfusions which helped to improve the survival rate of the wounded. Since the end of the Second World War the RAMC has served with the British Army wherever they have been posted, from Northern Ireland to Cyprus, Korea to Afghanistan, and many more. There are a variety of careers open to anyone wanting to join the RAMC. Officers can serve as doctor, pharmacist, physiotherapist, environmental health officer, medical support officer, or a technical officer (e.g. biomedical scientist, radiographer, clinical physiologist etc.) whist ordinary ranks can serve as combat medical technicians, emergency medical technicians, pharmacy technicians and many more.

RAMC World War I memorial, St Giles Cathedral, Edinburgh

It takes a special kind of courage to be in the middle of a battle and not to focus on the enemy but on the wounded instead; this has been recognised by the awarding of 29 Victoria Crosses to medical personal as well as 2 bars (a bar means that the recipient has been given a second Victoria Cross, and only 3 have ever been awarded). The corps also has one recipient of both the Victoria Cross and the Iron Cross, one officer was awarded the George Cross in the Second World War, and Private Michelle Norris became the first woman to be awarded the Military Cross following her actions in Iraq on 11 June 2006 when she was aged just 19.

Michelle Norris MC

In1856 Queen Victoria laid a Victoria Cross beneath the foundation stone of the Royal Victoria Military Hospital in recognition of the courage of those who have fought and died for their country. When the hospital was demolished in 1966 the VC, which is known as ‘The Netley VC’, was taken to the Army Medical Services Museum in Aldershot where it is now on display.
Those members of the Royal Army Medical Corps who have been awarded the Victoria Cross have truly lived up to the motto of the Corps – ‘Faithful in Adversity’.

Name Award Awarded while serving with Medal held by
Harold Ackroyd VC Royal Army Medical Corps att’d The Royal Berkshire Regiment Lord Ashcroft Collection
William Allen VC Royal Army Medical Corps att’d Royal Field Artillery Army Medical Services Museum
William Babtie VC Royal Army Medical Corps AMS Museum
William Bradshaw VC 90th Regiment (The Cameronians) AMS Museum
Noel Chavasse VC
and Bar
Royal Army Medical Corps att’d The King’s (Liverpool Regiment)
Bar: same
Imperial War Museum
Thomas Crean VC 1st Imperial Light Horse (Natal) AMS Museum
Henry Douglas VC Royal Army Medical Corps AMS Museum
Joseph Farmer VC Army Hospital Corps AMS Museum
John Fox-Russell VC Royal Army Medical Corps att’d The Royal Welch Fusiliers AMS Museum
John Green VC Royal Army Medical Corps att’d The Sherwood Foresters AMS Museum
Thomas Hale VC 7th Regiment (The Royal Fusiliers) AMS Museum
Henry Harden VC Royal Army Medical Corps att’d 45 Royal Marine Commando AMS Museum
Edmund Hartley VC Cape Mounted Riflemen, SA Forces AMS Museum
Anthony Home VC 90th Perthshire Light Infantry AMS Museum
Edgar Inkson VC Royal Army Medical Corps att’d Royal Inniskilling Fusiliers AMS Museum
Joseph Jee VC 78th Regiment (The Seaforth Highlanders) AMS Museum
Ferdinand Le Quesne VC Medical staff Corps Jersey Museum
Owen Lloyd VC Army Medical Department AMS Museum
George Maling VC Royal Army Medical Corps att’d The Rifle Brigade AMS Museum
William Manley VC
Iron Cross
Royal Regiment of Artillery
Awarded Iron Cross 1870
Private Collection
Arthur Martin-Leake VC
and Bar
VC: South African Constabulary
Bar: Royal Army Medical Corps
AMS Museum
Valentine Munbee McMaster VC Royal Army Medical Corps
Winning his VC during the relief of Lucknow, while serving with the 78th Highlanders
James Mouat VC 6th Dragoons (Inniskilling) AMS Museum
William Nickerson VC Royal Army Medical Corps Privately held
Harry Ranken VC Royal Army Medical Corps att’d King’s Royal Rifle Corps AMS Museum
James Reynolds VC Army Medical Department AMS Museum
John Sinton VC Indian Medical Service AMS Museum
William Sylvester VC 23rd Regiment (The Royal Welch Fusiliers) AMS Museum
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