J8cboes from Tbe )Dast

J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from 298 J8cboes from tbe )Dast. THE ARMY SURGEON, AND THE CARE OF 'l'HE SICK AND WOUNDED DURING THE GREAT CIVIL WAR. , By CAPT. H. A. L. HOWELL. Royal Army Medical Corps. PART 1. THE Civil War brought about several important changes in the medical organisation of our army. During the Elizabethan and early Stuart periods the unit of medical organisations in the field was the Company-each company having its own surgeon and medical equipment. The Civil War witnessed the disappearance of company surgeons and the introduction of the regimental system. Protected by copyright. Each regiment was now to have its surgeon, assisted by one or two junior surgeons known as "Surgeon's Mates." The new system, based on the unit of the regiment, existed in our army for over two centuries, but was soon supplemented by an extra regimental medical staff, which had charge of the staff of the Army and of the large general hospitals. There were many reasons for the disappearance of the company system. The provision of a surgeon to each company necessitated a very large number of surgeons. It had always been found difficult to obtain sufficient medical officers for the army, and in order to keep up their numbers, surgeons had, at times, to be obtained by http://militaryhealth.bmj.com/ impressment. The provision of company surgeons had been almost entirely in the hands of the captains of companies, and they, only too often, neglected their duty in this respect, and either supplied no surgeons at all, or enrolled as surgeons men who were not in any way qualified to hold that position. The Royalist troops were chiefly volunteers who served largely without pay. We are not therefore surprised to find that, although the Royalist Army Medical Staff included many able men, it was not strong in numbers. Parliament had control of the resources of the State, and was thus able to pay its soldiers and surgeons well. on September 25, 2021 by guest. Both sides, however, had great difficulty in maintaining a sufficient medical staff, and their armies were, in fact, largely dependent for medical aid on the local practitioners of the districts in which they happened to be. It is probable therefore that, owing to financial J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from Echoes from the Past . 29~ considerations and the want of supply of efficient surgeons,· the abolition of the company system became necessary in both armies. We must not forget, however, that on the Continent Gustavus Adolphus had, for reasons similar to those given above, already introduced in his army a regimental system of medical aid. In his Scots Brigade1 each battalion, consisting of 1,008 men, had four surgeons attached to it, and, later, we find the number of surgeons in the brigade reduced, four surgeons being in charge of 8,316 men. (These surgeons received pay at the rate of 32 Rix dollars a month, which sum, according to Mackay, would be equivalent to £28 in modern English money.) Before the outbreak of the Civil War in England the Continent was the field to which numerous English, Scots, Irish, and Welsh proceeded to receive training in the art of war. Scots and Welsh flocked to Gustavus; English sought service under Williamof Nassau; and the Irish ' adventurers usually found their way into the French armies. When the Civil War broke out, numbers of these veteran soldiers returned to their native country and joined one side or the other. There is no doubt but Protected by copyright. that the organisation of the English and Scotch regiments in the field was largely based upon Continental models. It is therefore probable that the medical arrangements .also came under the same influence. Although, as a matter of fact, there were, during the Civil War, never sufficient surgeons in either army to provide a full comple ment of company surgeons, the company surgeon was not definitely abolished until 1655. Before the outbreak of the Civil War the ranks of Physician General and Surgeon-General were practically unknown. There had been a Physician - General to the Army in Ireland, and http://militaryhealth.bmj.com/ Woodall had been Surgeon-General to the East India Company, but these were apparently the only two appointments to these ranks prior to the Civil War. The continuation of the war soon brought to notice the necessity of some professional superintendence of the medical arrangements of armies in the field, and we now find, in the Parliamentary armies at least, that this was recognised. To each of the Parliamentary armies was appointed a Physician General, a Surgeon-General, and an Apothecary-General. It would appear, from a reference in Wiseman, that Leslie's Scottish army on September 25, 2021 by guest. I This Scots Brigade afterwards entered the French service, where it was joined by some officers of the Scottish Guard and became the Regiment d'Hebron. Later it became part of the British Army, and is now represented by the ~oyal Scots. J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from 300 Echoes jTor;n the Past also had a Surgeon-G~neral; but this was, I believe, the only ap pointment to that rank on the Royalist side. In the Royalist armies the physicians and surgeons on the staff of the General presumably directed the medical arrangements. When Royalty was in command the duties of superintending surgeon were ap parently performed by the Sergeant-Surgeon, but there is no direct evidence that such was the case. The Civil War was also associated with the first appearance in our army of hospitals definitely set aside for wounded and sick soldiers, and with the institution of an organisation for the relief of the sick and wounded, for those who were permanently disabled, and for the soldiers' widows and orphans. In the early part of the war the Royalist army was better equipped and better manned than its opponent, and its medical arrangements were probably more complete. Parliament, however, held London, and the Company of Surgeons, which had for some years directed the medical arrangements of the army and controlled Protected by copyright. the supply of army surgeons, was also on the Parliamentary side. The Universities of Oxford and Cambridge were at first able to supply Charles's army with many able physicians and surgeons, in addition to those whose loyalty had already led them to join the forces of their King; but as the war went on, London, Cambridge and Oxford came under the control of Parliament. These sources of supply of medical officers were thus practically cut off from the Royalists, and the longer the war continued the better the Par liament was able to supply surgeons and physicians to its forces. As time went on, the medical arrangements in the Parliamentary armies steadily improved, whilst the opposite was the case on the http://militaryhealth.bmj.com/ Royalist side. The Royalist medical staff, however, certainly always included many men eminent in their profession, such as Harvey and Wiseman, and, in times of truce, they were consulted by many Parliamentarians. When the Parliamentary army was in need of more surgeons the Corporation of Surgeons was usually called upon to provide them. An extract from the Journals of the House of Commons, dated October 12, 1644, shows that the Corporations of Surgeons and Apothecaries were empowered to obtain surgeons by impress ment if necessary. It runs: "Ordered that it be referred to the on September 25, 2021 by guest. Masters and Wardens of the Apothecaries and Surgeons, to make choice of able and fit men for surgeons to be sent to my Lord General's army; and if such as be chosen and be appointed by them shall refuse to go, that they repair. to the Committee of the J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from Echoes from the Past 301" Militia; and that they give orders to the pressing of thelhfor the said service." The impressment of surgeons as well as of soldiers for military service was no novelty. On the outbreak of the Irish Rebellion in 1641 it had been enacted that the justices, &c., should "raise as many men by impress for soldiers, gunners, and chirurgeons as might be approved by His Majesty and both Houses of Parliament." Many of the soldiers and surgeons so levied for service in Ireland were ultimately embodied in the Pa'rliamentary forces employed in England. The war began by the King raising his standard at Nottingham on August 22, 1642. At, first the Royalists were most successful, especially in the West of England. A great battle was fought at Edgehill, on October 23, 1642. The battle is of little interest to the medical reader, but one may note that Harvey, the discoverer of the circulation of the blood, was present at the battle in his capacity of Physician to the King. We read that, during the battle, "a little aside, under a hedge, might be seen an elderly Protected by copyright. man reading a book. This was Harvey, and beside him were two boys of whom he had charge. The elder was afterwards. Charles n., the younger James n." After the battle Harvey accompanied t~e King to Oxford. He quitted the King's service in 1646.

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