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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

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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

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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. At Edgehill, also, the King's Standard-bearer, Dr. Edward Verney, was slain. After Edgehill the Royalists fell back upon Banbury and Oxford, and the Parliamentarians retired to Warwick. , The Parliamentary wounded who could not be carried away were, to the number of two hundred, left at Keinton. On the Tuesday after the battle Ruped and his troopers raided the town, and the wounded" were all most inhumanly slain by him." (So http://militaryhealth.bmj.com/ writes Nehemiah Wallington, but Ludlow, who also refers to the incident, does not state that all were slain.) This was an unusual incident, for in most cases the wounded were treated fairly well on both sides, and were not always detained as priso:lers of war if they fell into the enemy's hands. vVhen Prince Rupert took Bristol, in 1643, the Articles of Capitulation provided that the garrison should be allowed to march out to Warminster, together with the sick and wounded, and those unable to be moved on account of sickness or wounds were to have liberty ~o depart when they recovered. Similar articles were drawn up when Skippon's Par­ on September 25, 2021 by guest. liamentary army in the west surrendered to Prince Maurice, in 1644. It was provided that "all sick and wounded shall lie at Foy (Fowey) till they be cured." The Parliamentary sick and wounded were, however, afterwards ill-treated and robbed of their clothing J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

.302 Echoes f1'om the Past by the Cornish women. As a general rule, the surgeons wer') · well treated by both sides, and were rarely detained as prisoners if they fell into the hands of the enemy. They were, on occasion, permitted to enter hostile camps or fortresses to attend to any of their own party who might be prisoners and required medical aid. In 1644, one Henry Johnson, Surgeon of the King's own troop. wrote to the Parliamentary Governor of Newton Pagnell, requesting the release of his apprentice,. who had been taken prisoner in a skirmish at Kidlington. In March of the same year, when Lord Fairfax was defeated before Pontefract, his wounded were taken into the Castle, and we find Col. Lowther, the Royalist Governor, writing to Lord Fairfax that there was a want of medicaments for the number of Parliamentary wounded, and that one of the Parlia­ mentary surgeons, "a chirnrgeon of your party," was doing what he could for them. Fairfax wished to send his own surgeon into Pontefract, but the Governor refused, saying, "I shall join my own surgeons with one of your party, a prisoner here, to use the best Protected by copyright. · of their art in the cure of the poor wounded soldiers." Then, as now, the surgeon ran the same risks of wounds as his combatant comrades. An instance may be quoted. When Ludlow was besieged with a company of foot and a troop of horse in "\Varder Castle, in Worcestershire, in 1642-43, he wrote: "Our medicines were now spent, and our surgeon, who with eight of his brothers served at that time in my troop, shot through the body and disabled, though the bullet glancing, missed the vitals." During this siege truces were made at different times to enable the wounded to be removed. When the besieged yielded, their sick and wounded were left for a time in the Castle, and, after" a popish priest, very solemnly, http://militaryhealth.bmj.com/ with his hands spread over them, had cursed them three times, were carried from thence to Bristol." During the siege of Nottingham, where Col. Hutchinson was the Parliamentary Governor, we find that he had no surgeon in the Castle, but the wounded of both sides, "for want of another surgeon, · were brought to the Governor's wife, and she having some excellent balsoms and plaisters in her closett, with the assistance of a gentle­ man that had some skill, drest all their wounds, whereof some were dangerous, being all shotts, with such successe, that they were all well cured in convenient time." (This lady was the daughter of Sir on September 25, 2021 by guest. Allen Apsley, Lieut.-Governor of the Tower during the time Sir WaIter Raleigh and Mr. Ruthen were prisoners there. Lady Apsley is said to have had some skill in medicine, and to have assisted Raleigh in his chemical experiments.) J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

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It may be of interest to note that, during the many sieges of the Civil War, the usual provisions laid in for a siege were butter, cheese, bacon, dried fish, " bread corne," beeves, and beer. Siege operatio:o.s were usually attended by a great deal of sickness amongst the troops. When possible, troops were billeted upon the inhabitants, for only the superior officers were provided with tents, Frequently, as at Newark, the besiegers were obliged to sleep in the open, either in the fields or on straw in the trenches. When the Earl of Essex besieged and took Reading, in 1643, the mortality from sickness among his troops, which was attributed to the "in­ fected air of the town," was so great that he was obliged to fall back towards London, and quartered his sickly troops at Kingston and other neighbouring towns. Essex also sent large numbers of those who were seriously ill to London for treatment. In fact, London now became the base to which all the chronic cases of sickness and of severe wounds were sent by the ParlIamentary forces. Parliament arranged with the hospitals of St. Thomas, Protected by copyright. . St. Bartholomew, Bridewell, and Bethlehem, for the reception of all sick and wounded soldiers sent to them, and agreed to pay for their" cure and diet" whilst in hospital. The expense incurred on this account, however, became so great that, in 1644, Parliament compounded with these hospitals for this expenditure by exempting them from all taxation. At St. Bartholomew's, in 1644, 1,122 " maimed soldiers and other diseased persons" received treatment; and at St. Thomas's, in the same year, 1,063 persons were admitted to the hospital, "whereof a great number have been soldiers." Ultimately the numbers of sick and wounded became so great that

these hospitals were unable to cope with them, and Parliament was http://militaryhealth.bmj.com/ therefore obliged, in November, 1644, to establish a large military hospital at the Savoy. This hospital was under the direction of Commissioners appointed by Parliament. We may note that throughout the greater part of the war the establishment of military hospitals, and the control of the expenditure incurred in arranging for the care of the sick and wounded in the Parliamentary armies was entrusted to Commissioners appointed by Parliament; and these Commissioners, who were attached to each of the Parlia­ mentary armies, reported directly to the Speaker of the House of Commons. The superintendence of medical concerns by the on September 25, 2021 by guest. Physician-Generals and Surgeon-Generals of the different armies was confined to purely medical affairs. They appear to have re­ ported to their Generals, who, in turn, reported to headquarters in London. J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

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. At .this time, Dr. St. John was" physician to the traIn and person," and Lawrence Lowe'" surgeon to the traiu'and.person,"·in Essex's army. Each of the regiments on the Parliament side had a surgeon and his mates, and these mates were frequently appren­ tices of the surgeon, that is, they were not fully qualified men .. On July. I, ] 643, the House of Commons "ordered that Dr. Paul de Laune and Dr. Nathalean Chamberlaine; Physicians, be forthwith sent to the army for the service of the Army; and the House €loth declare that whatever physicians or surgeons shall be employed by the House, shall have the same allowances as others formerly have had. And the two surgeons now to be employed shall have their chests furnished with medicines, each of them to the value of twenty pounds." The Masters and Wardens of the Apothecaries wer:e also directed to view the chests "that they bee good." These chests, which contained the medical and surgical equipment carried by each surgeon and physician, varied in cost during the war. Before the war, in 1626, the surgeon's chest cost £17, and, if he required Protected by copyright. additional drugs or surgical dressings, he indented upon the Surgeon­ Major,who had a reserve chest, "of £48 valew." Surgeons-Major had now disappeared; and if the surgeon or physician required additional medicines, he obtained them by indent on the Apothecary­ General-an official who first appeared in our army during the Civil ,Var, whilst surgical necessaries and external remedies were indented for on the Surgeon-General. In 1643 the surgeon's chest cost £20. ,Vhen Cromwell's army was being equipped for the Scotch campaign of 1650, each surgeon's chest cost £15, and the surgeon was allowed £10 for a horse to carry it, and two shillings a day for the up-keep of the horse. In 1652 thirteen surgeons' http://militaryhealth.bmj.com/ chests cost, on one occasion, £181 Os. Id.; on another, £196 19s.; but a fortnight later £183 6s. were paid for twelve surgeons' chests. These were for the army in Ireland. The surgeon's chest was carried on a horse's baqk. In Ireland there was, at times, a scarcity of medicines owing to the difficulty of replenishing the chests. General Ludlow describes, 111 his memoirs, the great loss he suffered when fighting in Clare, the pack-horse, with the medicines, having fallen into the river and been carried away by the current. We read in the" Mercurius Anglfcus "that, after the first battle on September 25, 2021 by guest. of N ewbury, in which the Royalists were victorious, the Rebels "were forced to leave behind them heavy carriages, with many barrels of Whiskey and Pistoll Bullets and very many chirurgeon's chests full of medicaments." On this occasion King CharlesL sent the following order to the Mayor of N ewbury :- J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

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"Our will and command is that you forthwith send into the townes and villages adjacent, and bring hence all the sicke and hurt souldiers of the Earl of Essex's army, and though they be Rebels and deserve the punishment of Treators, yet out of our tender compassion upon them, as being Our subjects, Our will and pleasure is that you carefully provide for their recovery, as well as for those of our Own Armay, and then to send them to Oxford. Given, &c." " To the Major of N ewbury and the officers thereof." When Charles fell back after the second battle of N ewbury, the Royalist wounded were left behind at Donnington Castle, and ultimately fell into the hands of the Parliamentary army. After the battle of N aseby, in 1645,the prisoners, many of whom were wounded, were collected together and placed under guard in Harborough Church. The number of Parliamentary wounded was so large after this battle that it became necessary to collect them together in the town of Northampton, and owing

to the want of sufficient surgeons to attend to them, Parliament Protected by copyright. sent a number of surgeons from London. Skippon had been severely wounded in the battle, having received a shot in the side. He was one of the most able .of the Parliamentary leaders, and the House, in its anxiety, sent a skilled surgeon from London to attend him. In the same year Prince Rupert was besieged in Bristol. There was a great deal of illness in the town, for plague had broken out there. ]'airfax's army took the town by storm on September 11. The sickness spread to the Parliamentary troops, and was so bad that Fairfax (as he tells us in one of his letters) was obliged' to

march his army out of the town and go to Caversham and Penfold. http://militaryhealth.bmj.com/ Firth quotes a characteristic letter from the Parliamentary Com­ missioners, Pinder and Leighton, to Speaker Lenthall, which describes the arrangements for the care of the sick and wounded after the capture of this city. They wrote: " We shall 110W make bold to present you with an accompt of the being and wel-being of such wounded men as were left here, after the taking of the citty and Barclay Castle, for whom, according to the Generall's order and our best judgment, we appointed an hospitall, and placed therein so many as the house could conteine, with nurses and chirurgeons fitting for them, and as our number increased we added house-roome on September 25, 2021 by guest. and attendants to them: which though a house of great receipt yet not sufficient to hold all our foot soldyers, we caused the horse to be quartered in the country, which hath been one addition to theyr burthen; though not in giving free quarter-which we have paied J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

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in money for the most part-yet in disquiet of theyr houses, dis­ truction of theyr beddinge, linnen, and consumption of theyr fiering, which hath been the more enforced, the generality of theyr wounds being fractures of bones and dismemberinges by plugg-shott from the enemy, expressing height of malice, rather than martiall prowesse. Sir, we bless God the greater number are returned to the Army, well recovered." Wallington notes that in 1645 fifty-three men who had been prisoners in Oxford, and who had been" cut, hacked, and wounded," were sent by Sir Thomas Fairfax to London in carts and there taken to hospital. In November of this year there was a great outbreak of sickness amongst the Parliamentary troops whilst at Autree, engaged in the siege of Exeter. In 1645 Parliament reorganised its army. "The pay of the private soldier was much above the wages earned by the great body

of the people." Parliament, by its." self-denying ordinance," got Protected by copyright. rid of its weaker generals, and, under Cromwell's guidance, the army was entrusted to the care of those generals who had proved their worth and skill during the war. The ranks, which even in Hampden's regiment had contained large numbers of "hirelings whom want and idleness had reduced to enlist," "a mere rabble of tapsters and servillg-men out of place," were now filled with a better class of men and subjected to a sterner code of discipline. At the same time, in order to bring the army up to a proper strength, numbers of soldiers had to be raised by impressment. On the whole, however, the standard of the soldier was raised socially and morally by the remodelling, and the change .bore good fruit, http://militaryhealth.bmj.com/ not only in an increased fighting efficiency in the field of battle, but ill an improvement in the health of the army. During the war, at Bristol, Newark, Leeds, Chester, Manchester, Liverpool, and other towns, outbreaks of plague were associated with the movement of troops or with siege operations. vVar typhus was fearfully common during the first two years of the war, but, strange to say, as Dreighton points out, after }1'airfax and Cromwell took command of the Parliamentary Army the health of the troops greatly improved, and during the later years of the war, typhus-the invariable companion of troops during the wars of the seventeenth and on September 25, 2021 by guest. eighteenth centuries-became almost unknown. It is probable that when the army was remodelled new camp regulations were intro­ duced and rigidly enforced, and greater care paid to th~ health of the troops, although we have llO positive records of this. It is J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

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certain, however, that the discipline of the army was greatly improved by the remodelling, and regulations of all kinds were more thoroughly carried out. When the New Model Army was established, two physicians and an apothecary were appointed to the headquarter staff of the army. "The" physicians to the Army" were Drs. Payne and Strawhill; the apothecary was Master Welb. Each of the armies in Ireland and Scotland had its own Physiciall­ General, Surgeon-General, and Apothecary-General, an arrangement which was to last for many years after the restoration. Of these, the Physician-General ranked highest. At this time very few of the physicians to the army are mentioned in the Roll of the College of Physicians, but the Physician-General to an army was usually a man of some eminence in his profession. Dr. Henry Glisson was Physician-General to Manchester's army. Dr. Samuel Barrow was Physician-General to Monk's Scottish army. Barrow was a man of some political importance in his day and took a lead-, Protected by copyright. ing part in the intrigues which led to the restoration of Charles n. He enjoyed Monk's confidence to a large extent, and was not only Physician-General to his army, but also Judge-Advocate. Cromwell's army in Ireland had as Physician-General, Dr. John Waterhouse: Cromwell evidently had a high opinion of vVaterhouse, for soon after Cromwell had become Chancellor of Oxford' Univer­ sity, he wrote the following letter to Dr. Greenwood, the Vice­ Chancellor :-

" Edinburgh, Febn~ary 14th, 1650.

" Sir,-This gentleman, Mr. vVaterhouse, went over into Ireland http://militaryhealth.bmj.com/ as Pnysician to the Army -there; of whose diligence, fidelity, and abilities I had much experience. \,yhilst I was there he constantly attended the army; and having to my own knowledge, done very much good to the officers and soldiers, by his skill and industry; and being upon urgent occasion lately come into England, he hath desired me to recommend him for the obtaining of the Degree of Doctor in that science. Wherefore I earnestly desire you that, when he shall appear to you, you will give him your best assistance for the obtaining of the said Degree; he being shortly to return back to his charge in Ireland. By doing whereof, as y.ou will on September 25, 2021 by guest. encourage one who is willing and ready to serve the public, so you will also lay a very great obligation upon, Sir, " Your Affectionate Servant, "OLIVER CROMWELL." J R Army Med Corps: first published as 10.1136/jramc-03-03-20 on 1 September 1904. Downloaded from

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Waterhouse was therefore" Created Doctor of Physic by virtue of the letters of Oliver Cromwell, General," on March 1'2, 1651. Carlyle says Waterhouse had been" a student heretofore for eighteen years in Trinity College, Cambridge," and that he was a native of Great Greenford, in Middlesex. Cromwell also had a " Chirurgeon to his excellency's person ana train," one James Winter, and there was a "Chirurgeon-General to the officers of horse," Thomas Trapham. These received pay at the rate of 4s. a day, and each had two "mates," who received 2s. 6d. a day. Samuel Moule appears to have been the surgeon to Cromwell's Ironsides. (To be contimted.) Protected by copyright.

• http://militaryhealth.bmj.com/ on September 25, 2021 by guest.