Introduction

The precursor of the RAMC was founded by Charles II in 1660 as an individual medical service for every regiment of the Standing Regular Army. Each regimental medical service comprised of a medical officer (Regimental Surgeon), a warrant officer (Assistant Regimental Surgeon) and a medical assistant. Traditionally, the regimental bands-men served as stretcher-bearers.

In 1855 a Medical Staff Corps was created. Soon afterwards - 1857 - it was reorganised and renamed the Army Hospital Corps. Then, in 1898, the separate regimental medical services and the Army Hospital Corps were amalgamated. On the 23rd June, Queen Victoria, by Royal Warrant, formally made them into a Royal Corps - the Royal Army Medical Corps (RAMC).

Before 1914, the Boer War (1899-1902), was the last time the RAMC had been involved in really major military operations, although there were many minor actions across the red inked globe of Empire.

At the outbreak of The Great War, the RAMC served a Regular Army of only 247,432 men. It is amazing, therefore, that the RAMC was so well founded that it was able, by and large, to successfully undertake the medical needs of almost six million soldiers on the Western Front alone during the Great War. The worldwide British casualty total in the Great War was 11 million, most of who passed through the hands of the RAMC at some point.

The historical perspective of this situation is readily stated. After the scandal of the needlessly high casualty toll of the Crimean War (1854-56), an assumption had taken firm hold. This was that not only was there was a moral imperative to care for the health of soldiers, but also that there was also a self-serving military interest. Thereafter, the role of the Army Medical Services acquired increasing importance in military strategic thinking.

That this medical care philosophy had strong justification, is amply supported as, even today, there is a strong belief in military circles that the possibility of rapid medical evacuation and effective treatment, is one of the most important morale maintenance factors in a modern army. And, indeed, the current protracted wrangles about the Gulf War Syndrome would have been resolved long ago, if the vaccination records been more meticulously kept in the rush to inoculate the servicemen and women for immediate service in the Gulf in 1990-91.

The Great War

The key to the effectiveness of the RAMC in the Great War was inevitably bound up in the availability of trained medical staff and, in particular, medical, surgical and dental officers. Fortunately, the RAMC was able to recruit ample numbers of qualified medical officers, surgeons and paramedical staff from the UK civil population. By the end of the war nearly 13,000 doctors (50% percent of all UK civilian doctors) had been recruited into the armed forces; often to the detriment, it must be said, of the health care of the UK civilian population. Initially, women doctors were robustly refused the opportunity to serve on active service, but the inexorable demands of the War meant their role was slowly expanded to all the many theatres of war. However, no female doctor was commissioned in the RAMC in the Great War.

Long before the time of Florence Nightingale (1820-1910), there had been female military matrons and nurses. In the Great War, female matrons and nurses served in increasing numbers with the Queen Alexandra's Royal Imperial Nursing Service - QARINS (now Queen Alexandra's Royal Army Nursing Corps - QARANC). Many women - doctors and paramedics - chose to work for the duration in the war-time medical services outside of the aegis of the RAMC/QARINS, e.g. The Red Cross and the Women's Hospital Organisation - WHO. (Not to be confused with the World Health Organisation which was founded in 1948).

Role of RAMC

The role of the RAMC in 1914 was, even by today's standards, amazingly wide. Apart from the provision of medically qualified staff, of which the Regimental Medical Officer (RMO) was a particularly effective icon - and had been so since 1660 - the principal role of the RAMC was the medical evacuation of casualties from the battlefield, their treatment and rehabilitation and subsequent return to duty. On the Western Front, the non-battle casualties (60%) still exceeded those caused by warfare (40%). But the proportion of non-battle casualties in the Great War on the Western Front were still markedly less that those incurred in most earlier wars. However, in those theatres of the Great War which were located in the tropics, diseases such as malaria and gastro-intestinal infections often caused enormous losses in man-power, e.g. the East African Campaign, 1914-18.

In the early battles of the Western Front, battle casualties were due primarily to artillery-fire (60%), followed by that from firearms (35%) and smaller arms such as hand-grenades, bayonets etc. - (5%).

Nine months into the War there began what was to become an avalanche of toxic gas poisoning cases; firstly with chlorine, later mustard gas. A total of 185,000 cases were recorded with 7,000 fatalities. Almost all the cases were on the Western Front. Overall, gas cases represented about 10% of British casualties although, of course, the fatality rate was much lower than this (0.4%). Whilst many minor toxic gas cases were returned to duty, most of the really seriously affected were permanently debilitated and many suffered an early death some years after the War had ended.

There were also a significant number of 'shell shock' cases, amongst which there were, proportionally, many officers. After a very chaotic and ill-informed start, treatment for this condition improved, as it became better understood. A system of care was established, albeit with limited success, at both the field and referral hospital level. Most of the more serious 'nervous' cases never returned to active service and some were affected for the remainder of their lives.

Modus operandi

Early on in the war, the principle was instituted of the early treatment of all casualties at the point closest possible to their incapacitation. This involved a progressive evacuation down the line, via the Field Ambulance and the Clearance Hospital. According to need, this was: Regimental Aid Post (RAP); Advanced Dressing Station (ADS); Main Dressing Station (MDS); Casualty Clearing Station (CCS); and Base Hospital to the ultimate referral point of the UK specialist hospital. Hence the well known 'Blighty Wound'. Ultimately, a figure of 55% 'Wounded - Returned to Duty' is said to have been achieved. In the period of March to August 1918, on the Western Front, 300,000 wounded soldiers were returned to their units. Some soldiers received wounds on several occasions and were successfully treated and returned to duty on each occasion.

New methods and means

The introduction of inoculations against tetanus and typhoid had enormous effects on the fatality rates. All Great War soldiers routinely received anti-typhoid inoculations. And many of the wounded were given anti-tetanus injections. Furthermore, x-rays and blood transfusions were progressively introduced, as were the techniques of aggressive debridement (excision of damaged wound tissue) and other effective surgical interventions. Gas gangrene, for which there was no effective inoculation (anti-serum) until 1918, was the almost inevitable outcome of soil contaminated wounds. It often affected 90% of the hospitalised wounded from the earlier battles, particularly when there were long delays before treatment; a situation almost par for the many intensive intra-trench 'offensive' battles such as the First Battle of the Somme in 1916. Lost in 'no-man's land' was reality to many a wounded soldier and considerable numbers of the RAMC and the regimental stretcher-bearers lost their own lives attempting the recovery and movement of the wounded off the battlefield.

As the war progressed the RAMC made huge strides in the rehabilitation of amputees, the paralysed and the blind. Early attempts at plastic surgery also met with some success.

The preventive health side of the war was also tackled by the RAMC with vigour. In October 1914 the Sanitary Section organisation in the field was completely overhauled.

In the past, the intimate contact of so many men at war in such small, confined spaces, inevitably brought about the unsanitary conditions which led to epidemics such as enteric (typhoid), plague, smallpox, dysentery, cholera and typhus. These were largely kept at bay on the Western Front, but new Trench Diseases such as Trench foot, Trench Fever and Trench Mouth became important causes of debility and a drain on military strength. Veneral diseases (at times as high as 0.4% of all infections) also posed a serious problem with the lack of any antibiotics to combat them.

In the long tried and tested ways, the RAMC tackled these problems of sanitation from the regimental level with, as always, the RMO, in the van. Regimental sanitary squads were established with wide-ranging responsibilities ranging from latrine management to the provision of potable water and bathing and delousing centres. Regular courses were held for NCO's, passing on these techniques of preventive health. Over 3,000 soldiers were trained in hygiene at the RAMC School of Health Instruction in France alone during the Great War.

At the strategic level the RAMC was instrumental in the introduction of important protective materiel such as steel helmets* - the British 'tin bowler' being by far the most effective in the war - gas masks and other protective clothing.

Fortunately, the high casualty rates caused by the Spanish Influenza epidemic did not occur on the Western Front until mid-1918 when the final German offensive had been largely contained; but in any event the Central Powers were as badly affected as the Allies.

The vital role of the RAMC in the Great War is amply illustrated by the large number of awards for gallantry that were received by all ranks, including service-women; uniquely, its honour roll includes two VC's with bar. In total, there were 6501 military awards including 7 Victoria Crosses, 499 Distinguished Service Orders (25 with bar**), 1,484 Military Crosses (184 with bar), 3 Albert Medals, 395 Distinguished Conduct Medals (19 with bar) and 3,002 Military Medals (199 with bar).

In additional to its care of the medical needs of the Army, it also served the Royal Flying Corps and the Royal Airforce until the establishment of the RAF Medical Service in October 1918.

There is no memorial to the RAMC on the Western Front. A memorial window was dedicated in Westminster Abbey in May 1927.

* The British WW1 steel helmet was specifically designed for trench warfare with the aim of protecting the head and shoulders from shell shrapnel and splinters and debris from shell bursts. It was not primarily intended to provide protection from rifle and machine gun fire and only rarely did so.

** A bar indicates that the medal was awarded for gallantry on two separate occasions.

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