Royal Army Medical Corps

The Royal Army Medical Corps (RAMC) is a specialist corps in the British Army which provides medical services to all Army personnel and their families, in war and in peace. The RAMC, the Royal Army Veterinary Corps, the Royal Army Dental Corps and Queen Alexandra's Royal Army Nursing Corps form the Army Medical Services.

Medical services in the British armed services date from the formation of the Standing Regular Army after the Restoration of Charles II in 1660. This was the first time a career was provided for a Medical Officer (MO), both in peacetime and in war.[2] For much of the next two hundred years, army medical provision was mostly arranged on a regimental basis, with each battalion arranging its own hospital facilities and medical supplies. In 1793 an Army Medical Board was formed, which promoted a more centralised approach drawing on concurrent civilian healthcare practices.[3] The Board set up five General Military Hospitals, four in the naval ports of Chatham, Deal, Plymouth and Gosport (Portsmouth), and one (known as the York Hospital) in Chelsea; the hospitals received large numbers of sick and injured soldiers from the French Revolutionary Wars (so much so that by 1799 additional General Military Hospitals were set up in Yarmouth, Harwich and Colchester Barracks).[4] The Board was criticised, for both high expenditure and poor management; by the end of the century the Board had been disestablished, and the General Hospitals were closed or repurposed not long afterwards.[5]

In place of the Army Medical Board, the office of Director-General of the Medical Department was instituted, with James McGrigor serving in that role from 1815 to 1851.[3] McGrigor, who has been called the Father of Army Medicine,[6] had served as principal medical officer under the Duke of Wellington during the Peninsular War, during which time he had introduced significant changes in the organisation of the army's medical services, placing them on a far more formal footing.[7] The regimental basis of appointment for MOs continued until 1873, when a coordinated army medical service was set up. To join, a doctor needed to be qualified, single, and aged at least 21, and then undergo a further examination in physiology, surgery, medicine, zoology, botany and physical geography including meteorology, and also to satisfy various other requirements (including having dissected the whole body at least once and having attended 12 midwifery cases); the results were published in three classes by an Army Medical School, which was set up in 1860 at Fort Pitt in Chatham,[8] and moved in 1863 to Netley outside Southampton.[9]

There was much unhappiness in the Army Medical Service in the following years as medical officers did not have military rank but "advantages corresponding to relative military rank" (such as choice of quarters, rates of lodging money, servants, fuel and light, allowances on account of injuries received in action, and pensions and allowances to widows and families). They had inferior pay in India, excessive amounts of Indian and colonial service (being required to serve in India six years at a stretch), and less recognition in honours and awards. They did not have their own identity as did the Army Service Corps, whose officers did have military rank. A number of complaints were published, and the British Medical Journal campaigned loudly. For over two years from 27 July 1887 there were no recruits to the Army Medical Department. A parliamentary committee reported in 1890, highlighting the doctors' injustices. There was no response from the Secretary of State for War. The British Medical Association, the Royal College of Physicians and others redoubled their protests.[10] Eventually, in 1898, officers and soldiers providing medical services were incorporated into a new body known by its present name, the Royal Army Medical Corps; its first Colonel-in-Chief was Prince Arthur, Duke of Connaught.[11]

The RAMC began to develop during the Boer War of 1899–1902. The Corps itself lost 743 officers and 6130 soldiers in the war. However, far more of them, and thousands more of the sick and wounded they treated, would have died if it had not been for the civilian doctors working in South Africa as volunteers—such as Sir Frederick Treves, Sir George Makins, Sir Howard Henry Tooth and Professor Alexander Ogston—who, having seen how unprepared to deal with epidemics the RAMC and the Army itself were, decided that a radical reform was needed. Chief among them was Alfred Fripp, who had been chosen by the Imperial Yeomanry Hospital Committee to order all the necessary materials and medical personnel, and oversee the setting-up of a private hospital at Deelfontein to cater, initially, for 520 'sick and wounded.' The contrast between the smooth working of the IYH at Deelfontein with the chaos of the RAMC hospitals, where an enteric epidemic had overwhelmed the staff, led to questions in Parliament, mainly by William Burdett-Coutts. In July 1901 the first meeting of the Committee of Reform took place, with all the aforementioned civilian experts, plus Sir Edwin Cooper Perry, making up half the number; the rest were Army men, and included Alfred Keogh, whom the new Secretary of State for War, St John Brodrick, later Earl of Midleton, appointed Chairman of this Committee and the subsequent Advisory Committee. Neither would have met so soon—if at all—but for Fripp's concern to limit unnecessary suffering, and for his ten years' friendship with the new King, Edward VII. Fripp showed him his plans for reform and the King made sure that they were not shelved by his government. Part of his plan was to move the Netley Hospital and Medical School to a Thames-side site at Millbank, London. Cooper Perry, Fripp's colleague from Guy's Hospital, was instrumental in making this happen, as well as using his formidable talents as an organizer in other services for the Reform Committee. Fripp and Cooper Perry were knighted for their services to the RAMC Committee of Reform in 1903.[12]

During the First World War, the corps reached its apogee both in size and experience. The two people in charge of the RAMC in the Great War were Arthur Sloggett,[13] the senior RAMC officer seconded to the IYH in Deelfontein who acquiesced in all Fripp's surprising innovations, and Alfred Keogh, whom Fripp recommended to Brodrick as an RAMC man well-regarded when Registrar of No.3 General Hospital in Cape Town.[14] Its main base was for long the Queen Alexandra Military Hospital at Millbank, London (now closed).[15] It set up a network of military general hospitals around the United Kingdom[16] and established clinics and hospitals in countries where there were British troops. Major-General Sir William Macpherson of the RAMC wrote the official Medical History of the War (HMSO 1922).[17]

Before the Second World War, RAMC recruits were required to be at least 5 feet 2 inches tall, and could enlist up to 30 years of age. They initially enlisted for seven years with the colours, and a further five years with the reserve, or three years and nine years. They trained for six months at the RAMC Depot, Queen Elizabeth Barracks, Church Crookham, before proceeding to specialist trade training.[18] The RAMC Depot moved from Church Crookham to Keogh Barracks in Mytchett in 1964.[19]

The corps established a network of home-country military hospitals for military casualties during the First World War. The hospitals were managed by Territorial Force personnel and were headquartered as follows:[16]

The military medical services are now a tri-service body, with the hospital facilities of Army, Royal Air Force and Royal Navy combined. The main hospital facility is now the Royal Centre for Defence Medicine at Queen Elizabeth Hospital Birmingham, a joint military-National Health Service centre. The majority of injured service personnel were treated in Selly Oak Hospital in Birmingham prior to the new Queen Elizabeth Hospital's opening. There was press coverage critical of the standard of care during the surge of UK military commitments in the years following the second invasion of Iraq,[43] but it was later reported that the care provided to injured troops had significantly improved.[44][45]

Queen Alexandra Hospital in Portsmouth, Derriford Hospital in Plymouth, Friarage Hospital in Northallerton (near Catterick Garrison) and Frimley Park Hospital (near Aldershot Garrison) also have military hospital units attached to them but they do not treat operational casualties.[46]

Since the Victoria Cross was instituted in 1856 there have been 27 Victoria Crosses and two bars awarded to army medical personnel.[50] A bar, indicating a subsequent award of a second Victoria Cross, has only ever been awarded three times, two of them to medical officers. Twenty-three of these Victoria Crosses are on display in the Army Medical Services Museum. 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. A young member of the corps, Private Michelle Norris, became the first woman to be awarded the Military Cross following her actions in Iraq on 11 June 2006.[51]

One VC is in existence that is not counted in any official records. In 1856, Queen Victoria laid a Victoria Cross beneath the foundation stone of the Royal Victoria Military Hospital, Netley.[52] When the hospital was demolished in 1966, the VC, known as "The Netley VC", was retrieved and is now on display in the Army Medical Services Museum.[52]

Within the military, Medical officers could occupy a number of roles that were dependent on experience, rank and location. Within military documentation, numerous abbreviations were used to identify these roles, of which the following are among the most common.[53]

Since 1903, the corps has published an academic journal titled the Journal of the Royal Army Medical Corps (JRAMC). Its stated aim is to "publish high quality research, reviews and case reports, as well as other invited articles, which pertain to the practice of military medicine in its broadest sense".[54] Submissions are accepted from serving members of all ranks, as well as academics from outside the military. Initially a monthly publication, it is currently published quarterly by BMJ on behalf of the RAMC Association.[54][55]

The Museum of Military Medicine is based at Keogh Barracks in Mytchett in Surrey.[56]

From 1898 to 1984, the RAMC maintained a staff band in its ranks. The earliest record of music in the RAMC was in the 1880s when a Corporal of the Medical Staff Corps was sent to Kneller Hall to be trained as a bugler. It was founded officially in 1898, with official permission for the band being given by the Duke of Connaught, first Colonel-in Chief of the RAMC. In 1902, the band had reached a stature to where it could take part in the Coronation Procession of King Edward VII. On 1 January 1939, the RAMC Band was taken over by the Army Council and was officially recognised as a state sponsored band. In 1962, Derek Waterhouse became the first official Drum Major to be appointed to the band. It was disbanded in 1984, being one of the first to go in the as a result of the restructuring of the Army. It is today retained in the Army Medical Services Band.[57]