RAMC

Army Medical Officers
And the Malta Garrison 1800–1898

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Introduction

William Franklin
Inspector of Hospitals William Franklin
1763–1833 (Rochester Cathedral)
William Franklin
Inspector of Hospitals William Franklin
1763–1833 (Rochester Cathedral)

The expulsion of the French from Malta in September 1800, and the subsequent establishment of a British administration, unwittingly enmeshed army medical officers in the delivery of local health services. Staff Medical Officers became members of the Board of Health, managed the lazaretto and the quarantine department, organised and ran the charitable institutions, and sat on the Board of Management of the lunatic asylum.

In 1802, Inspector of Hospitals William Franklin was the Principal Medical Officer of the garrison, and head of the Board of Health. In addition to his military duties, Franklin superintended the lazaretto and the quarantine department. On leaving Malta in 1806, the task of safeguarding the public health devolved on his successor, Deputy Inspector of Hospitals Ralph Green. In 1811, Green was succeeded by Deputy Inspector of Hospitals William Pym. Pym, however, only spent a short time in Malta, and during his absence, the quarantine department was managed by Garrison Surgeon Joseph Thomas, who also acted as president of the Board of Health. Thomas had the task of opening pest hospitals during the plague epidemic of 1813. In July 1813, another army medical officer, Deputy Inspector of Hospitals Robert Grieves took over the reins of the lazaretto.

Among the medical officers involved in the running of the charitable institutions were: Deputy Purveyor Richard Cleave, who became Purveyor to the civil hospital Valletta, Purveyor to the hospital of Santo Spirito Rabat, and a member of the permanent committee of management of the House of Industry; Edward Jefferson a Purveyor's Clerk to the civil hospital; Naval Surgeon Joseph Becket Henry Collings, who in September 1848 was installed Inspector of the Charitable Institutions; Surgeon–General William Alexander Mackinnon, who in 1881 became a member of the Medical Board of the lunatic asylum; and Surgeon–General John Harry Ker Innes, who in 1874 chaired a medical commission ordered by government to investigate the sudden increase in mortality of the Maltese Islands.

John Davy
Physician to the Forces John Davy MD
(Lt Col Foster's collection of Netley photos - Courtesy AMS Museum)

A posting to Malta provided opportunities for talented officers to broaden their scientific knowledge. Physician to the Forces John Davy remarked that the advantages derived from foreign service "may justly be ranked as one of the most considerable, combining the pleasure and profit of travel, with professional duties and culture, so that individuals, if intent on self improvement, may derive at the same time a double benefit".1 In 1842, Davy, in his Notes and Observations of the Ionian Islands and Malta, described in great detail the geology, flora, and climate of the Maltese Islands. He bemoaned the fact that during a period of 26 years of almost universal peace, when many hundred well educated and intelligent medical officers had been employed in the colonies, little had been contributed by them to the general stock of knowledge in proportion to their means and abilities.

Time devoted to research did not contribute towards an officer's prospects of promotion. Nonetheless, valuable work was carried out by a number of dedicated officers such as Andrew Leith Adams 22nd Foot, who became renowned for his geological and palaeontological work in Malta. Adams described the island as a plateau raised above a submerged Mediterranean basin, which had once formed part of a vast continent, where elephants and hippopotami roamed. During his six years in Malta, (June 1860 to March 1866), Adams discovered two additional fossil elephants, in addition to the pigmy elephant previously known. Andrew Leith Adams was made a Fellow of the Royal Society in acknowledgment of his work on the dentition and osteology of the Maltese fossil elephants.2

Several medical officers left a number of publications. In 1810, Physician to the Forces William Domeier produced his Observations on the climate, manners, and amusements of Malta. This book served as a guide for invalids arriving at Malta for the benefit of their health. Staff Surgeon William Henry Burrell and Staff Surgeon James Dillon Tully left an account of the plague of 1813; Surgeon Andrew Leith Adams and Assistant Surgeon Francis Henry Welch contributed a paper on the cholera epidemic of 1865; while Assistant Surgeon Jeffery Allen Marston, and Surgeon Captain Matthew Louis Hughes elucidated Mediterranean Fever, whose causative agent was isolated on 9 July 1887, by Surgeon Captain David Bruce at the Valletta Station Hospital.

Over 1,240 medical officers served in Malta during the colonial era. Between the defeat of Napoleon at Waterloo on 18 June 1815, and the outbreak of war with Russia in March 1854, Europe passed through a phase of relative tranquility. Life on the island was pleasant. Mundane garrison duty went on uneventfully, punctuated sporadically by visitations of cholera during the years 1837, 1848, 1850, 1865, and 1867. Medical officers settled down to garrison life. They celebrated weddings, shared the joys of new life, and comforted one another when death took away cherished members of their community.

Some medical officers got married in Malta. Surgeon David Reid McKinnon 21st Foot, married Annie Caroline Arrowsmith at St Paul's Anglican Cathedral Valletta, on 22 June 1858. On 29 March 1880, Surgeon Major George Clerk Irving married Agnes Henrietta Sammut, aged 23 years, daughter of physician Joseph Sammut. On 27 January 1827, Surgeon Thomas Fiddes married Anne Galland aged 16 years. Anne was the only daughter of Captain James Galland Royal Malta Fencible Regiment. Their first three children were born in Malta. Fiddes died on his passage to Nova Scotia in 1836, leaving a young widow, who remarried in Malta in 1840. Physician to the Forces John Davy married in England in 1830. His spouse accompanied him to Malta during his tour of duty from 1828 to 1835. Margaret Fletcher Davy had three children. Their second daughter, Elizabeth Mary Davy was born in Malta in October 1832, but died of consumption in 1857. Their second son, Humphry Davy, was born in 1837. He died of scarlet fever in 1842.

Ethel Davidge
Ethel Frances Josephine Davidge aged 5 yrs 8 mths died of diphtheria 8 Oct 1884
(Ta' Braxia Cemetery Pieta)
Surgeon Francis Odell
Surgeon Francis Odell 94th Foot died on 19 Aug 1870 aged 38 years
Mary Odell
Mary Odell daughter of Francis Odell died 8 Oct 1870 aged 6 yrs.
(Ta' Braxia Cemetery Pieta)

Infant deaths from infectious diseases, accidents, or malnutrition were borne with stoic resignation. The death from drowning of Harry Corte Innes, only son of Surgeon–General John Harry Ker Innes, at St Julian's Bay, on 14 November 1874, was an inestimable loss. His parents must have been inconsolable when, some weeks later, on 21 December 1874, their youngest daughter, Mabel Geraldine aged 3 years, followed her brother to the grave.

Garrison Surgeon Joseph Thomas, Assistant Surgeon Joseph Lindsey Curtis 18th (Royal Irish), Brigade Surgeon John Davidge, Purveyor James Holmes, Surgeon Peter Nevill Jackson 31st Foot, and Staff Assistant Surgeon Alfred Lewer all lost children while serving at Malta. The spouse of Surgeon Francis Odell, 64th Foot, buried her husband, and within two months laid to rest her six year old daughter, Mary.

Malta was also a congenial place for retirement. Many remained here after completing their military service. Among these were Apothecary to the Forces William Tiffin Iliff, and Purveyor Richard Cleave. Iliff died in Malta in 1830, aged 51 years. While serving with the garrison from 1801 to 1822, he had established a large obstetric practice. Purveyor Richard Cleave lived at 60 Strada San Rocco Birkirkara. Cleave died of apoplexy on 15 September 1850, aged 74 years. He left a widow and an unmarried daughter, who on the death of her mother sought relief from charitable funds, as dense cataracts prevented her from securing a living.

What did young medical gentlemen expect to gain from a life wandering with their regiments from one campaign to the next, and from one foreign posting to another? Despite being gentlemen of a learned profession, medical officers were looked down upon as civilians attached to the military. They were not entitled to any military honours, and soon discovered that the military offered them neither status nor adequate remuneration. As they had only relative rank, they occupied a position below the most junior ensign. The medical colleges dissuaded their students from seeking a commission, until their status and pay had improved. Few, therefore considered joining the Army Medical Department, unless they had family ties with the army, were seduced by the glamour of the uniform, or considered an adventurous life and the comradeship of the mess more rewarding than the accumulation of personal wealth. Consequently, the Army Medical Department endured a perennial shortage of medical officers who sought their fortune elsewhere.

This article examines the Medical Department of the Army from the turn of the 19th century to the formation of the Royal Army Medical Corps on 23 June 1898. It looks at the path trodden by medical gentlemen through their medical education, their commissioning in the army, their military career, and the terms and conditions of service under which they served.

The Army Medical Department

The Army Medical Department managed the Staff Medical Officers and the regimental officers, and made the necessary medical arrangements for overseas expeditions. It had its origins during the Seven Years War, (1756-1763), when Secretary of State at War Lord William Barrington, established a Hospital Board for the medical service of the army intended to take the field, that under their constant direction this part of military service, (relating alike to medicines, hospital stores and every other requisite provision for the sick), might be carried into execution with ability, regularity and despatch.3

Previously, in 1747, the Royal Warrant of George II had established the hereditary post of Apothecary-General. This mandated a perpetual furnisher, with remainder to his heirs, of all the medicines necessary for the general service of all the land forces in Great Britain.4 This hereditary monopoly was infringed by regimental surgeons. Before 1783, surgeons were paid a sum proportional to the strength of the corps, which they used to supply the regiment with the necessary medicines. Medicine money augmented their pay of 4 shillings a day, by as much as £50 to £70 a year. In 1783, stoppage from the soldier's pay for his medicines was abolished, and the government granted each regiment an allowance of £70 to £120 a year. In November 1796, this too was discontinued, and medicines were once again furnished by the Apothecary-General. The pay of surgeons was then fixed at 11s 4d in the cavalry and 9s 4d in the infantry, so as to compensate them for the loss of profits they had previously made on the drugs they had supplied.

Walcheren
The Walcheren Inquiry into the misconduct of the Army Medical Board by Thomas Rowlandson published 30 March 1810. Look Ass Peeps stands for Lucas Pepys, TK for Thomas Keate. Both were pilloried for the inefficiency of the Board. Robert Jackson, a perpetual thorn in their side, mocks them while riding an ass.
(Courtesy of Wellcome Images)
Hatchment
Funeral Hatchment Sir Lucas Pepys First Baronet with the motto "A man is what his mind is". Sir Lucas married Jane Elizabeth Countess of Rothes in 1772. She died in June 1810. In 1813, Pepys married Deborah daughter of Anthony Askew. Sir Lucas Pepys was born on 26 May 1742 and died on 17 June 1830.
(St Michael's Church Mickleham Surrey)

In 1790, the Army Medical Department was administered by Physician General Clifton Wintringham, (Nov 1786–Jan 1794), and Surgeon–General John Hunter, (Mar 1790–Oct 1793). Hunter was also Inspector of Regimental Infirmaries. In 1793, on the outbreak of the Revolutionary Wars against France, the duties of the Inspector of Regimental Infirmaries were separated from those of the Surgeon–General and vested into a third member. This new Army Medical Board consisted of Surgeon–General John Gunning (Oct 1793–Feb 1798), Physician General Lucas Pepys (Jan 1794–1810), and Inspector of Regimental Infirmaries Thomas Keate (Feb 1793–Feb 1798). Keate became Surgeon–General in February 1798, and was succeeded by Inspector of Regimental Infirmaries John Rush. The Board had the sole right of recommending individuals for commissions and officers for promotion. Its members were instructed to always consult together regarding appointments.3

In December 1801, Francis Knight (1801–1810), became Inspector General of Army Hospitals following the death of John Rush. Knight exercised control over all the hospitals, including the regimental hospitals. He closed down the General Hospitals as it was cheaper to treat soldiers in regimental hospitals, even though these lacked the capacity to treat large numbers of sick disembarking from foreign expeditions.

The regulations of 1798 transformed regimental surgeons into contractors and managers of expenditure. On admission, surgeons had to record each patient in a register, and make daily reports of the progress of their illness irrespective of the triviality of their condition. The register had to include all medicines prescribed together with the daily diets. They had to keep a register of vaccinations against small pox, a register for the monthly abstracts of the diets and hospital expenditure, one for the monthly returns of the sick, one of half yearly returns of medicines and materials, one of half yearly returns of stores and instruments, as well as a weekly return of the sick to their commanding officer and Principal Medical Officer. The case books became abhorrent to most officers as they were regarded more as a deterrent against ordering any extra food for the patients, than a record of professional interest. If anything beyond the bare diet was ordered for a sick man his case had to be entered in the book and updated daily. The surgeon had to write on each patient's diet sheet his complete list of extras for that day and his diet for the morrow. In 1804, Knight created a number of Deputy Inspectors with the sole purpose of cutting down expenditure in the regimental hospitals. The inspectors descended on the regimental surgeons and minutely examined their books. James McGrigor remarked that "through this pedantic and rigorous economy in trifles, the higher professional interests and those of science were almost wholly sacrificed to pence".4

In July 1809, Sir Lucas Pepys, then President of the Royal College of Physicians of London and President of the Army Medical Board, refused to proceed to Walcheren to report on the large number of sick of that ill fated expedition. Sir Gilbert Blane, Physician to the Fleet, went out instead. The Medical Board was made the scapegoat for the high mortality at Walcheren. Its further criticism by the Fifth Report of the Commissioners of Military Enquiry of 1808, on its extravagant expenditure, led to its dissolution.

On 2 March 1810, Director General John Weir (Feb 1810-June 1815), Principal Inspector Theodore Gordon and Principal Inspector Charles Ker formed a new department. They were jointly vested with the same powers and patronage as individually possessed by the former Board, but were prohibited from private practice. Theodore Gordon retired on 12 July 1810, and was succeeded by William Franklin. On 13 June 1815, James McGregor (later McGrigor), took over from John Weir as Director General. Deputy Inspector of Hospitals William Somerville replaced Charles Ker, who had resigned following the elevation of McGregor. In 1816, the two principal inspectors were discontinued, but in 1818, William Franklin was restored as professional assistant to the Director General. He remained in office until his retirement through ill health on 1 July 1833.

James McGrigor
Sir James McGrigor, mezzotint by William Ward, after John Jackson
(Courtesy of Wellcome Images)

Throughout their service, officers of the Army Medical Department had a number of grievances. They complained about: (i) their low status (ii) the insignificance of their relative military rank (iii) their poor pay (iv) the excessive length of foreign service (v) slowness of promotion (vi) inadequate retiring allowances (vii) the absence of honours and special rewards and (viii) the inability to take study or annual leave. Their concerns were investigated by the Royal Commission of 5 May 1857, chaired by Secretary of State for War Sidney Herbert. The commissioners recommended the establishment of an army medical school, the formation of a statistical branch, the establishment of two general hospitals, and improvement in the sanitary arrangements in army barracks. The Medical Staff Corps, formed in 1855, was disbanded and the Army Hospital Corps raised instead.

Report
Report of the Royal Commission into the medical department of the army 5 May 1857.

The recommendations of the Herbert's Committee were enshrined in the Royal Warrant of 1 October 1858, the so called Magna Carta for the Medical Department. This was regarded by medical officers as their bill of rights. The sixteenth and seventeen clauses of this warrant granted them relative rank, with all precedence and advantages attaching to the rank to which it corresponded, except as regards the presidency of Courts Martial. Their relative rank entitled them to a choice of quarters, rates of lodging money, servants, forage, fuel and light, or allowances in their stead, and prize-money.

It did not take long, however, before their newly acquired privileges were gradually whittled away. On 31 December 1858, a General Order emanated from Horse Guards, depriving army medical officers of their right of presidency at all boards when they were the senior officers. This General Order, though acted on, did not receive the sanction of the Royal Prerogative till 1 May 1863. This Royal Warrant modified Clause 17 of the warrant of 1858, as follows: But such relative rank shall not entitle the holder to military command of any kind whatsoever, nor to the presidency of courts martial, courts of inquiry, committees or boards of survey; but when the president of such courts, committees, or boards, shall be junior to the officer of the civil department, then such member of the civil department shall attend as a witness, and not as a member.5

Senior surgeons never felt settled anywhere. They were never consulted as to where they would have liked to be posted. Dr Clapton, Dean of St Thomas' School, in his introductory address to the medical students, given on 1 October 1864, referred to Inspector General of Hospitals, William Charles Humfrey, a very able man with a large family, who had scarcely been settled at Aldershot six months, when he was ordered off suddenly to Malta. He could not afford to be on half-pay, and, though feeling acutely his hard lot, after nearly forty years' service, he went, and almost immediately died of fever. His widow is now grateful for the gift of £5 from a charitable society.6

Further discontent followed in the wake of the medical unification warrant of 1 March 1873.7 Under this warrant, medical officers were suddenly removed from their regiments, and cast adrift, in a most miserable state of uncertainty as to their future destination. All rosters being thus overturned, no concept could be formed of their next moves. To married men, this was no less unsatisfactory than the abrupt severance of social and regimental ties. No compensation was considered for the pecuniary losses they had incurred for change of uniforms, regimental mess and band subscriptions, or the money expanded on furniture and house rent by those who had counted on some considerable term of home-service.8

Dissatisfaction also ran high among Surgeons Major, who under the terms of the 1873 warrant were attached to regiments for five years. As a consequence of the withdrawal of the Assistant Surgeons, Surgeons Major in charge of regiments had to perform those trivial and trifling duties from which they had been relieved by promotion in earlier years. Such tasks, although not actually laborious, were irksome, involving as they did early morning work, the inspection and certification of prisoners, attendance on women and children, with occasional summons to professional duty in the middle of the night. Sanitary inspection and a host of minor drudges now fell exclusively to the lot of the Surgeon Major, who found it impossible to take his six months leave, except as a favour from the Principal Medical Officer.8

The unification system was intended to incorporate the medical officers into one family, so that they might regard the Medical Department as their real corps, and thus increase their influence both for their own benefit, and for the good of the Service. The intention had been to reorganize the department so as to improve the knowledge and expertise of the medical officer by exposing him to a greater number and variety of diseases than was attainable in the small regimental hospitals. Unfortunately, the warrant of 1873 secured none of its intended objectives. It was expected that vested interests would be respected, and that no one actually in a regiment would be removed from it, except with their own consent. It was also hoped that, as it was the intention of Government to reduce the establishment, and to get more work out of its officers, a higher rate of pay and allowances, with some improvements in rank and prospects, would also be granted. Instead, however, the only change was the withdrawal of the rise in the surgeon's pay after fifteen years' service, and the practical abolition of the forage allowance. The former was restored, but not without a struggle, and the forage allowance was only re-introduced to those who could prove that being mounted was essential for carrying out their duties.9

Sir William Mure Muir, who had taken control of the Army Medical Department in April 1874, devoted himself to the consolidation of the new unification system. In this undertaking he met with great opposition, and, like his predecessor Sir Thomas Galbraith Logan, under whose rule the disruption of the old combination of staff and regimental medical officers had occurred, he had to encounter a vast amount of obloquy. One of Muir's strongest opponents was Surgeon–General James Mouat VC, who in his pamphlet of 1875, argued in favour of the benefits that would be incurred to the surgeon through the re-introduction of a modified form of the Regimental System.10

The Royal Warrant of 28 April 1876 altered the medical officer's terms and conditions of service. All regimental appointments were abolished. The department became unified. All fixity of tenure was done away with. Irrespective of the length of a man's service, all were liable to be moved anywhere and everywhere at the discretion of the administrative officers. Surgeons were to start on £250 a year, which with allowances, raised their income to £318. They received no further increases until they had completed ten years' service. However, as most were sent almost immediately to India, where their maximum pay for the first five years was 317 rupees (£300), in reality they received a drop in pay by £18 a year. Medical officers were now to enlist for a short service of ten years, at the end of which, six were to be selected annually for promotion into the higher ranks, the remainder being dispensed with. All, but the six selected officers, on their return into civil life were to receive a sum of £1,000 in lieu of all pension on retirement. Promotion to the rank of Surgeon Major was guaranteed to all who had completed twelve years' full-pay service, and the examination for promotion to the rank of Surgeon Major was abolished. To unblock promotion, Muir set a compulsory retirement age of 55 years for Surgeons-Major and Surgeons, and of 60 years for Surgeons-General and Deputy Surgeons-General.11

Unfortunately, the 1876 warrant failed to attract candidates. No entrance examination took place in the winter of 1876, as only 12 candidates had applied to fill the 38 available vacancies (five of whom had been previously rejected). On 2 December 1879, the War Office promulgated the Royal Warrant of 27 November 1879.12 This abolished the ten year commission, increased the rates of pay and retiring allowances, and offered other material advantages so as to improve the popularity of the department and fill its attenuated ranks. Medical officers by the new warrant were divided into two classes. Class A embraced all medical officers who had entered the department before the warrant of 1876; Class B officers were those who had been admitted for a limited period of ten years' service under the warrant of 1876. Class B officers had the right to become Class A officers if they applied within two years from the date of the new 1879 warrant, and if favourably recommended by the Director General. Those Class B officers who did not accept the offer to transfer, and elected to serve on the original conditions, retained the chance of being one of the six to remain in the service, and promoted after twelve years to the rank of Surgeon Major.13

Under the 1879 warrant, the Secretary of State reserved for himself the privilege of appointing one half of the candidates by nomination from such qualified candidates as were proposed by medical schools in the United Kingdom and the colonies. The other half was to be filled by the competitive entrance examination. The warrant was a great improvement on its predecessor. Seventy four candidates presented themselves before the London examiners in December 1879, from whom sixty five were selected. However, as seven more came up to the minimum standard, they were accepted by the authorities, evidently on account of the pressing need for army medical officers. In the London examination, Mr Frederick Rowland Barker headed the list with a score of 2,590 marks out of 3,100, which was the limit for the compulsory examination. He was followed closely by Alfred Keogh, a future Director General, with 2,525 marks.14

Army Hospital Corps
Memorial erected Jan 1884 to those of the AHC who died in Malta during 1881, 1882, and 1883 (Pieta Military Cemetery)
Adolphus Graham Pirie
Lt Adolphus Graham Pirie died at the Naval Hospital Bighi 5 Jan 1883, aged 27 yrs, from wounds received at Tel El Kebir
(Ta' Braxia Cemetery Pieta)

In July 1882, British troops converged on Egypt under the command of Lieutenant General Sir Garnet Wolseley. Complaints were made against the Medical Department in Egypt, where it was alleged that the system of medical service lately introduced into the Army had broken down. In 1883, a committee presided by Lord Morley carried out a thorough investigation of the care and treatment of the wounded. The committee found the allegations to be groundless, but recommended the amalgamation of the medical officers with the men of the Army Hospital Corps, an increase in the strength of the Army Hospital Corps, and the reintroduction of examinations for promotions from Surgeon to the grade of Surgeon Major, and for Surgeons-Major to that of Brigade-Surgeon.15

Lord Morley's recommendations were embodied in the Royal Warrant of 20 September 1884. This important document brought to an end the official constitution which up to that time had made the warrant officers, non-commissioned officers, and men of the Army Hospital Corps a distinct body from the staff of medical officers. The medical officers, by this warrant ceased to be officers of a separate department. Their title was changed. Together with the quartermasters of the Army Medical Department they were designated the Medical Staff of the army, and were put on the footing of staff officers. The attendants of the Army Hospital Corps, retook the designation by which they had been known in 1855, and became the Medical Staff Corps.16

The warrant empowered the Medical Staff to command all non-commissioned officers and men of the corps, all patients in military hospitals, and all such officers, non-commissioned officers, and men as might be attached for duty to the Medical Staff Corps. At the same time, it was clearly laid down that this command within the establishment of the Medical Corps did not confer any title to command outside the corps. The prefix Royal to the title of Medical Staff, which had been suggested as an appropriate addition by a War Office Committee in 1878, and by Lord Morley's Committee of 1883, was not conceded.

Despite an improvement in their pay the issue of substantive rank had not been settled. Discontent remained rife. The final slight came with the release of the Royal Warrant of 1 January 1887, which omitted all reference to, and so by implication abolished, relative rank, substituting it with a classified schedule, wherein medical officers were described as ranking as. This caused great discontent, as without military rank, medical officers lost their official and social status which military rank conferred. In addition foreign service was extended by a year, so that medical officers were required to serve in India almost continuously for six years, and four years in unhealthy colonial stations. The extension of foreign service became intensely unpopular. Medical Staff exercised their right to retire after twenty years service rather than serve the full six years in India. This increased the burden on those left behind, so that it was virtually impossible for officers to leave India, except on a medical certificate.17

During 1888, the Medical Staff of the Army was reduced. With the exception of the operations for the relief of Suakin, England was not involved in any conflicts. This enabled the War Office to reduce the strength of the Medical Staff by not filling up vacancies caused by death and retirement. In 1889, the number of medical officers dropped to 891, a level deemed unsafe by Director General Sir Thomas Crawford. Measures were taken to form a reserve of medical officers from the Volunteer Medical Service, which had been established by the Royal Warrant of 13 March 1866. This would enable the War Office to dispense with an increase of the regular Medical Staff by employing the reserves on Home Service, thus releasing the regulars for field service. To save money it was proposed to reduce the Medical Staff by placing the troops at home under the care of civilian practitioners at contract rates, and employing the regulars solely on foreign service. This proposal would have meant almost continuous service in India, for with the exception of Gibraltar and Malta, the number of foreign stations requiring more than a very few medical officers was very small.

In January 1889, the Secretary of State for War, Edward Stanhope, appointed a committee chaired by Lord Camperdown to re-examine the status and pay of the medical officers of the army and navy. His report published in March 1890, offered no increase in pay. It set the retirement age for executive ranks at 55 years, and at 62 years for the administrative ranks. Camperdown, (i) preserved the right of officers to retire after twenty years' service (ii) proposed a reduction of continuous foreign tours to five years instead of six so as to reduce the never ending strain of duty and the trying tropical climate (iii) introduced new compound rank titles such as Brigade-Surgeon-Lieutenant Colonel to reflect professional status alongside military rank (iv) recommended fewer changes in stations and in the duties of medical officers (v) proposed the abolition of the examination for promotion except that between Surgeon and Surgeon Major.18

James Mouat
Surgeon-General James Mouat
(Lt Col Foster's collection of Netley photos - courtesy AMS Museum)

On 15 May 1893, a deputation from the Parliamentary Bills Committee of the British Medical Association requested the Secretary of State for War, Mr Campbell Bannerman to introduce various amendments in the conditions of service of the Army Medical Department at home and abroad. Their main demand for the consolidation of the Medical Staff and the Medical Staff Corps in a unified Medical Corps, on lines similar to those of the Royal Engineers, Army Service Corps and and Ordnance Store Corps, was not granted. Neither were any alterations made to the cumbersome titles such as that of Brigade-Surgeon-Lieutenant Colonel, or to the regulations which required three years' service in a rank before retirement.19

On 22 January 1898, another deputation from the British Medical Association, which included Surgeon-General Sir James Mouat VC KCB waited on the Secretary of State for War Lord Lansdowne, at Lansdowne House. Mouat emphasized that the formation of medical officers and men into a corps, royal if possible, with definite army rank and military titles, was absolutely indispensable to enable them to perform their onerous duties efficiently. The time had arrived, stressed Mouat, to promote those reforms, which in his opinion would remove the chronic discontent which was ruining the prestige of the Army Medical Department, and very seriously affecting the efficiency of the service.20 This delegation succeeded where others had failed. On 4 May 1898, at a banquet given by the Lord Mayor of London at the Mansion House, Lord Lansdowne announced that the Army Medical Staff were to join with the Medical Staff Corps to form a new Corps. On 23 June 1898, was promulgated the Royal Warrant establishing the Royal Army Medical Corps.

Qualifications of Army Medical Officers

In the early 19th century, no uniform standard of medical education existed. Apprenticeships and attendance at lectures were the main entry route into the profession. The majority of regimental surgeons held the Licentiate of the Society of Apothecaries (LSA) and the Membership of the Royal College of Surgeons (MRCS). These two qualifications enabled them to practice as surgeon-apothecaries. Those who could afford a university education pursued a three to four year course before graduating with the degree of Doctor of Medicine (MD).

The Apothecaries' Act of 1815 empowered the Society of Apothecaries to examine and grant licences to successful candidates, and to regulate such practice through a syllabus of studies. The Medical Act of 1858, For the better regulation of medical practice throughout the United Kingdom, established a General Council of Medical Education and Registration of the United Kingdom. This council established a minimum standard of medical education. Only those who reached that standard had their names entered in the Medical Register, which was an official list of properly qualified practitioners. The standards of entry to the medical profession were defined by the Amending Medical Bill in 1886, when for the first time a medical student had to qualify in General Medicine, Surgery and Midwifery before his name could be entered on the Medical Register. A diploma of the Society of Apothecaries, if obtained under the conditions of the Act of 1886, was an acceptable qualification for those seeking a commission into the Army Medical Department. No additional stand alone qualification in surgery was required.

In London, students enlisted themselves at such teaching establishments as St Thomas's and St Bartholomew's Hospital. Others supplemented their lectures by enrolling at private schools like the Great Windmill Street School of Anatomy founded by William Hunter in 1768. Leading surgeons took on paying pupils, often accommodating them in their own homes as resident pupils. Thus, in 1809, Lorenzo Sammut studied physiology and surgery as a house-pupil of the anatomist Joshua Brookes, whose museum of human and comparative anatomy was second only to that of John Hunter. In the first half of the 19th century France was the undisputed leader in medical education and many students completed their studies there. In 1818, for example, Apothecary to the Forces Josiah Schembri proceeded to the Hotel-Dieu Hospital Paris, where for six months he attended lectures on the Practice of Medicine given by Dr J B Larroque.

Gavino Patrizio Portelli
Assistant Surgeon Gavino Patrizio Portelli 2nd/10th Foot

The medical education pursued by surgeons, Gavino Patrizio Portelli, (1795–1865), and John Bathurst Thomson, (1813–1850), gives us an insight into the qualifying standards of the period. Gavino was born in Valletta on 16 March 1795. In 1808, at the age of only thirteen, he commenced an 18 month course of lectures in anatomy given by the surgeon Francesco Buttigieg, who held the Chair of Midwifery at the University of Malta. Concurrently, he started a four year apprenticeship in his father's apothecary shop in Valletta. On 25 March 1809, Gavino was granted a warrant as a Dispenser of Medicines to the Garrison Hospital. On 2 July 1812, being desirous of a more extended field than Malta presented for acquiring professional knowledge, Gavino enrolled himself at the Westminster and St George's Hospitals, where he completed his studies at considerable cost and expenditure to his father.21

In London, Gavino undertook a 14 month course of lectures in anatomy, physiology, and surgery given by the former army Staff Surgeon Joseph Constantine Carpue. For four months, he sat in at lectures on pharmaceutic chemistry given by John Ayrton Paris, physician to the Westminster Hospital. In 1813, Gavino enrolled on a four month course of lectures on the theory and practice of medicine by Robert Hooper, and lectures on materia medica and chemistry by Joseph Ager.

As he had not yet reached the age of twenty-two, he was ineligible to sit for the membership of the Royal College of Surgeons. However, he passed the examination conducted before the Army Medical Board composed of Director General John Weir and the two Principal Inspectors Charles Ker and William Franklin. He was also approved by the Royal College of Surgeons London. On 6 September 1813, Gavino was commissioned Hospital Assistant to the Forces. He reported for duty at the Duke of York Hospital, Chelsea. On 27 November 1813, he embarked at Ramsgate on the Expedition to Bergen-op-Zoom.

Edinburgh course
Edinburgh course
TNA:WO 25/3927 AMD Form dated Jan 1835 showing John Bathurst Thomson's course of studies at Edinburgh University.

In December 1815, Gavino was reduced to half-pay. Officers on half-pay were encouraged by Director General James McGrigor to enhance their qualifications if they wished to progress in the service. In February 1816, Gavino took three courses of lectures in midwifery given by Samuel Merriman. Merriman was a physician-accoucheur to the Middlesex Hospital, the Westminster General Dispensary and the Parochial Infirmary of St George, Hannover Square. On 3 May 1816, Gavino became a Member of the Royal College of Surgeons, London. He was gazetted Assistant Surgeon 1st/10th Foot on 8 August 1816, and joined his regiment at Corfu.

Nineteen year old John Bathurst Thomson opted for a university education. He studied at the University of Edinburgh and the Royal Infirmary Edinburgh. In 1825, the medical course for the Edinburgh MD degree was extended from three to four years, when midwifery became a compulsory subject. Students for the MD Degree had to submit and publish a dissertation in Latin, although theses in English became acceptable from 1834. Thomson's thesis was entitled On Misplaced Gout. John Bathurst Thomson qualified in 1836 as a Licentiate of the Royal College of Surgeons (LRCS) and obtained an MD degree from the University of Edinburgh. We can see exactly the course of studies pursued by John Bathurst Thomson at Edinburgh from his application schedule to join the Army Medical Department in September 1836.22

Entry to the Army Medical Department

AMD Application
Entry requirements for the Army Medical Department January 1835

Applicants for the Army Medical Department were expected to have attained a broad and liberal education. In on the qualifications of medical officers in the army dated 1 July 1826, Director General James McGrigor specified that all should have studied Natural Philosophy, Mathematics and Natural History in all its branches, but a liberal education and a competent knowledge of the Greek and Latin languages are indispensably requisites in every candidate.23 The Royal Warrant of 1 October 1840 emphasized that no medical candidate who had not passed his examination at the Royal College of Surgeons of London, Edinburgh or Dublin, would be eligible for a commission.

At the start of the French Revolutionary Wars, the exigency of finding so many regimental and Hospital Mates for an expanding army led to the lowering of entry standards and the offering of inducements. McGrigor related how placards were posted on the college gates of Dublin, Edinburgh and Glasgow, offering commissions to such as could pass some kind of examination. During the first campaign in Flanders, every apothecary's boy that could be laid hold of, was taken into the service and employed in the hospitals as a surgeon's mate, even though most had very little knowledge of medicine or surgery.24

Similarly, on 24 April 1813, when more Hospital Mates were urgently required for the Peninsula, Director General John Weir informed the Royal College of Surgeons of Edinburgh, that their Diploma would henceforth be an acceptable qualification for a regular commission, in a similar manner to those from the London Colleges. We request, wrote Weir, that you make this known at Edinburgh as a number of well qualified persons for the junior ranks of the department are now wanted, particularly for the service of the Peninsula. It is proper to mention, that as the service of the Peninsula requires a number of persons for the inferior employment in the hospital, whose duties requirements do not call for much medical information, we have thought it expedient to relax the rule lately laid down of requiring 12 months attendance at a hospital and will now receive as Warrant Mates for Temporary Service, persons who have attended six months only at a hospital.25

One route of entry into the Medical Department was through the purchase of a regimental medical commission in a newly raised corps. This practice was abolished in 1783, but in 1793, James McGrigor was still able to buy the surgeoncy in General De Burgh's Regiment, 88th Connaught's Rangers, for £150, through the army agency of Cox and Greenwood.

AMD Application
Application form of studies of John Bathurst Thomson dated 2 September 1836

The majority of entrants had to prove that they had completed the required curriculum, pass the examination for an army commission before the Royal College of Surgeons of London, and demonstrate sufficient medical and surgical knowledge to the examiners of the Army Medical Board in London. Candidates for the Army Medical Department had to be unmarried, aged between 21 and 26 years, and not afflicted by a mental or Constitutional Disease or Physical Debility, that could interfere with the most efficient discharge of the Duties of a Medical Officer. They had to complete an application form, similar to the one submitted by John Bathurst Thomson on 2 September 1836. Thomson's schedule was annotated: 6 month deficient in the practice of medicine. However, on 12 September 1836, he was informed that his name has been entered in the list but from the many great number in it, 2 years must elapse before I can offer him prospect of appointment.22 Thomson was gazetted Staff Assistant Surgeon on 11 January 1839. He was 26 years. His chances of further promotion were slim. In 1840, there were 310 Assistant Surgeons, of which thirty had waited for promotion for upwards of twenty years.

Fortuitously, Thomson did not have to wait long on the staff before achieving a regimental post. The death of surgeon Walter Blake on 27 January 1839, sat in motion a chain of events, where Blake's post in the 61st Foot was filled by Assistant Surgeon James Smith 17th Foot, while Smith's empty position, enabled Thomson to be gazetted Assistant Surgeon 17th (Leicestershire) Regiment. Similarly, on 3 September 1847, on the formation of the Reserve Battalion 69th South Lincolnshire Regiment, Assistant Surgeon John Bathurst Thomson 17th Foot, was promoted surgeon to the newly raised battalion. Assistant Surgeon Nesbitt Hefferman 12th Foot, took Thomson's place in the 17th, and medical gentleman Arthur Stewart Willocks came off the waiting list to fill the vacancy left by Hefferman in the 12th Suffolk Regiment.

At the start of the Napoleonic Wars entrants to the department began their careers at the Army Depot at Newport, Isle of Wight. Others went to Portsmouth and served at the barracks at Gosport and Hilsea. Towards the end of the Napoleonic Wars, newcomers spent their first few months at the Duke of York Hospital, Chelsea. Invalids arriving at Chelsea to be pensioned off from the service were billeted in low public houses, where they got drunk and became a public nuisance. Consequently, from 1814, only invalids of the Household troops were examined at Chelsea, as these were kept in their barracks until called for. Invalids of the infantry were sent to the General Hospital at Fort Pitt Chatham.

The General Hospital at Fort Pitt was build in 1800 or 1801 and initially designated the Royal Hospital. It was organised into a medical and surgical division. In 1857, Staff Surgeon 1st Class Joseph Samuel Prendergast was in charge of the Medical Division. In charge of the Surgical Division was Staff Surgeon 1st Class John Charles Graham Tice, and Staff Surgeon 2nd Class George Williamson supervised the postmortems and the applications of splints and bandages by the probationers. The head of the whole establishment was Deputy Inspector General John Robert Taylor. The first army medical school opened at Fort Pitt in 1860. It moved to the Royal Victoria Hospital Netley in 1863.

Thomas Francis O'Dwyer
Assistant Surgeon Thomas Francis O'Dwyer holding an infantry undress forage cap with the regimental number above the peak. He wears an infantry patrol jacket decorated with a plain Austrian Knot on each sleeve. On each breast run four double cords fastened in the center with olivettes. The cords run away from the centre to form crow's feet before terminating in dropped loops.
John Waring Belcher
Staff Assistant Surgeon John Waring Belcher showing his rank on the collar of his plain tunic. Assistant Surgeons ranked as Lieutenants and wore a crown at each end of their collars. Staff Surgeons First Class ranked as Majors and wore a star. Staff Surgeons Second Class ranked as Captains and wore a silver crown and star at each end of their collar.
Joseph Burke
Staff Assistant Surgeon Joseph Burke shows the cocked-hat with black swan feather plume as worn by medical officers. The hat was of black silk, with bullions at each corner. On the right side of the hat was a braid with a button on its lower V-shaped end. A band of braid ran diagonally from the front to the back, midway between the corner bullion and the vertical braid.

After the Crimean War, entry to the Army Medical Department was via a competitive examination. The first was reserved exclusively for Acting Assistant Surgeons below the age of 25 years, who had served in the Crimea. These had been discharged after the war but were now given the opportunity to be restored to the service. The second examination was held on 27 May 1857 and was open to all. It consisted of a written part followed by oral questioning by three examiners: Deputy Inspector General Sir David Dumbreck, Staff Surgeon 1st Class Henry Pilleau, and Surgeon 2nd Class Francis Reid. Candidates who did sufficiently well appeared singly before the Director General Andrew Smith, who deplored, in Alexander Frederick Bradshaw's case, his ignorance of Natural History. The successful probationers were: Nicholas Ffolliott, Yorke Hobart Johnson, Ebenezer John Hatchell, Charles James Kinahan, Edward Louis McSheehy, Charles George Lumsden, James Parr, James Bowyer Baker, Thomas Allen Thornhill, and Alexander Frederick Bradshaw.26

On arriving at Fort Pitt in 1857, the probationers had to find their own accommodation in town, and support themselves for as long as it took to receive their commissions. No organised teaching took place, but probationers had to attend postmortems and carry operations on the cadaver. They were taught how to apply splints and bandages, and were indoctrinated in the correct completion of all the returns expected from regimental surgeons. The average stay at Fort Pitt was three months, but this was tempered by the demand for Assistant Surgeons. In May 1857, mutiny had broken out in India and medical officers were hurriedly dispatched to complete regiments to their war establishment. Alexander F Bradshaw was gazetted Assistant Surgeon Rifle Brigade on 24 July 1857. He was sent to India, where he served almost uninterruptedly for 21 years.

To gain a commission in the 1880s one had to sit for an examination consisting of a compulsory and a voluntary section. The four compulsory subjects with a total score of 4000 marks were: (a) anatomy and physiology (b) surgery (c) medicine including therapeutics and the diseases of women and children and (d) chemistry and pharmacy with a practical knowledge of drugs. The voluntary subjects were French, German and Natural Science. Three hundred marks were allotted to Natural Science, and 150 marks for each of the foreign languages. To obtain a commission a candidate had to qualify in the compulsory subjects by scoring a least a third of the marks in each of the four subjects. Once qualified they were able to improve their ranking if they obtained at least a third of the marks in each of the voluntary subjects. Successful candidates became Surgeons on Probation and attended a course of instruction in the Army Medical School at Netley.27

Regimental officers wore the same uniform as the combatants but were distinguished from them by their cocked-hat with black swan feathers, and by their black belts. Medical Staff wore a uniform consisting of a plain scarlet coat throughout, with buttons on which the inscribed words Medical Staff encircled the letter GR, in accordance with General Order Horse Guards, dated 18 February 1830. The tunic had gold epaulettes as worn by unattached officers and corresponding to the relative ranks in the army. Purveyors and Deputy Purveyors of Hospitals wore silver epaulettes.

The reform of the officers of the Army Medical Department and the men of the Army Hospital Corps in September 1884, led to the necessity of both being dressed in clothing of similar pattern and colour. Hitherto, the parade dress of medical officers had been scarlet, while that of the men of the Army Hospital Corps had been blue. Therefore, in order to assimilate the officers and men as regards their clothing, the medical officers of the army, as from December 1884, ceased to wear the red tunic, and appeared in blue.16

Army Service - Performance

Service John B Thomson
Service John B Thomson
TNA:WO 25/3902 Military Service of John Bathurst Thomson28
Bathurst Thomson memorial
Memorial to John Bathurst Thomson MD (22 Sept 1813—18 Sept 1850).
Bathurst Thomson memorial
To the memory of John Bathurst Thomson who died at Valletta on 18 Sept 1850 aged 36 years. This monument was erected by the officers, NCO and soldiers of the Corps to testify their universal affection and esteem. He fell a sacrifice to his unshrinking fidelity in the discharge of his duty during the prevalence of cholera in Malta MDCCCL
Wolseley William Owen
In the memory of Colonel William Owen Wolseley After a distinguished career during which he received special promotion for his services in the Ashanti Campaign 1895-6 he contracted Mediterranean Fever while Principal Medical Officer Malta and died on 3 June 1905 at Tilbury.
Henry Alfred Gilmour
Clara Jane Born 14 June 1871
Died 18 April 1872
Arthur Rudge Born 27 Oct 1874
Died 24 July 1875
Edgar Fraser Born 5 Oct 1879
Died 25 April 1880
Children of Sgt Henry Alfred Gilmour and Charlotte Army Hospital Corps
(Pieta' Military Cemetery)

An army career was not without its hazards. There was not only the long separation from family and friends, the deprivations of home comforts, and living in insanitary conditions on campaigns to endure, but also the real danger of being captured, maimed, and killed by the enemy. Regimental surgeons were exposed to the same risks of dying from wounds contracted on the battlefield, of yellow fever in the West Indies, and of typhoid lurking in insanitary barracks, as the troops they served with. Between 1 March 1796 and the end of 1799, 14 surgeons and 19 Assistant Surgeons died in the Leeward Islands from disease. Inspector of Hospitals John Hennen, PMO Malta from October 1821 to March 1825, died of yellow fever at Gibraltar in November 1828. In the cholera epidemic at Malta between 9 June and 13 October 1850, John Bathurst Thomson, and Assistant Surgeon John Caughey Gray 44th (East Essex) Regiment, lost their lives. Surgeon William Harvey 70th Foot was killed in the Indian Mutiny; Surgeon Francis Smith and William Abbott Anderson died at Balaclava of typhus fever; and Assistant Surgeon Thomas Carey 21st Foot was killed in the revolt of the slaves in Demerara, British Guinea in April 1807.

The service record of Deputy Inspector General of Hospitals Theodore Gordon, graphically elaborates the reality of service life. Theodore Gordon was possibly the son of Principal Inspector Theodore Gordon of the Army Medical Board. On 28 November 1803, Gordon entered the Medical Department as a Hospital Mate. He was only 18 years old.

On 23 November 1804, Gordon became Assistant Surgeon 91st Highland Regiment. In December 1805, the 91st Foot occupied Hannover as part of Lord William Cathcart's expedition. However, in the aftermath of Napoleon's victory at Austerlitz, France handed Hannover to Prussia and the British retired to Bremen. Bad weather delayed their transports to England till the beginning of February 1806.

In July 1808, Gordon and the 91st left Ireland for Portugal with the army of Lieutenant General Sir Arthur Wellesley. He was present at the Battle of Vimiera on 21 August 1808. Shortly afterwards, the French Army of Portugal under General Junot surrendered to Lieutenant General Sir Hew Dalrymple, in command of the British troops in the Peninsula, and the British entered Lisbon on 11 September 1808.

In the winter of 1808–09, British troops under Lieutenant General Sir John Moore advanced into Spain. Napoleon had poured a large force into the Peninsula, and with no allies to co-operate with him in the field, Moore was compelled to retreat towards Corunna. The Battle of Corunna was fought on 16 January 1809. During this campaign, Gordon was shipwrecked in the Douro on his passage to Oporto with a detachment of invalids from Sir John Moore's army. He was one of seven survivors, the rest of his eighty ill fated shipmates having perished in the vessel.

On arriving at Lisbon, Gordon was promoted surgeon 2nd/89th Regiment, then quartered in Jersey. He left the Peninsula and reached London, but was granted no leave to visit his relatives in Scotland, as he was immediately required to join the 89th for Gibraltar. In October 1810, he found himself on Lord Blaney's ill-fated expedition to Malaga, where he was fortunate enough to escape being taken prisoner.

On 28 March 1811, Gordon became Surgeon 4th (King's Own) Regiment who were at Ceuta. He proceeded with them to reinforce Wellington's Army in the Peninsula. Gordon was present at the Battles of Salamanca (22 July 1812), Vitoria (21 June 1813), and the sieges of Badajos (16 March-April 1812) and San Sebastian (31 August 1813 ). During the retreat from Burgos in October 1812, he was wounded in the leg by a shell.

Gordon was promoted Staff Surgeon in September 1813. He accompanied the victorious army into France, but sadly while crossing the Bidassoa River, (7 October 1813), he was wounded in the neck by a rifle ball. The projectile was not extracted until he returned to Portsmouth, where he was granted leave to spent the winter of 1813 with his relations in Scotland. He had been on constant active service for ten years.

On 9 September 1813, Gordon was appointed Staff Surgeon at Chelsea Hospital. He took the opportunity to obtain an MD from King's College, Aberdeen, and remained at Chelsea Hospital until the Battle of Waterloo, when all the medical officers were called up for service. He proceeded at an hour's notice to Brussels, and took charge of one of the largest hospitals for the wounded.

On 7 September 1815, Gordon was promoted Physician to the Forces. He became Deputy Inspector General of Hospitals on 29 January 1836, and was elected FRCP (London) in 1838. He died at Brighton on 30 March 1845, aged 59 yrs.29

Gordon's progress from Hospital Mate to Deputy Inspector General of Hospitals was in no way exceptional, many a young surgeon having trodden a similar path.

Table I shows the medical officers who died at Malta between 1800 and 1898. Many succumbed to tuberculosis, typhoid, or brucellosis, which was common in the Mediterranean littoral. Others died from diseases contracted during their service in the tropics. There were also those who were just worn out and were said to have died of debility. Their children were struck down with diphtheria, measles and scarlet fever. Suicides, drowning from boats overturning in the harbour, fatal head injuries and mortal compound fractures of the femur, sustained in falls off bolting horses occurred quite frequently. Assistant Surgeon Richard Townshend Grantham was an exception in that he did not die of natural causes, but was killed in a duel.

Table I Medical Officers who died at Malta 1800–1898
Name Age Rank Date of Death Condition Cemetery
Table I. Medical Officers who died at Malta 1800–1898.
Adrian Peter   Staff Surgeon 11 Sept 1804    
Adrien John Joseph 32 yrs 2 mth Staff Assistant Surgeon 22 Aug 1862 Febris Remittens Capuchin's Crypt
Brown David   Assistant Surgeon 85th 6 June 1825    
Burns James   Surgeon 18th 21 Dec 1823 Debility  
Cleave Richard 69 yrs 6 mths Purveyor 15 Sept 1850 Apoplexy  
Cook George Williams Harry 26 yrs 9 mths Staff Surgeon 22 Dec 1884 Tuberculous Meningitis Rinella Military
Dwyer Joseph Hamilton 37 yrs 6 mths Surgeon 14th 10 July 1857   Msida Bastion
Frost William   Dep Purveyor 6 Sept 1814    
Gaisford Stephen   Assistant Surgeon OMD 26 Dec 1822 Dropsy  
Geoghegan William 36yrs 1 mth Surgeon Major 83rd 18 Aug 1882 Pulmonary TB Ta Braxia
Grantham Richard Townshend   Assistant Surgeon 27th 4 May 1805 Killed in a duel  
Gray John Caughey 25yrs 6 mths Assistant Surgeon 44th 14 July 1850 Cholera Rock Gate
Hall Augustus Robinson 41 yrs 2 mths Surgeon Major 4 Feb 1880 Diseases contracted
in the Afghan War
Ta'Braxia
Hall Richard 31 yrs Staff Assistant Surgeon 7 Mar 1870 Debility Ta'Braxia
Hopkins Radford John 84 yrs 3 mths   28 June 1848    
Humfrey Alexander 44 yrs 6 mths Surgeon Major 98th 8 Feb 1876   Ta' Braxia
Humfrey William Charles 60 yrs Inspector General 29 Apr 1862 Intermittent Fever Ta' Braxia
Iliff William Tiffin 51 yrs Apothecary 12 Oct 1830   Msida Bastion
Irvine William 35 yrs Physician 23 May 1811    
Irving George Clerk 39 yrs 10 mths Surgeon Major 22 Oct 1855 Dysentery Ta' Braxia
Irwin James Napper   Surgeon 97th 21 Feb 1847 Haematemesis  
Ives John   Surgeon 31st 5 Feb 1809    
James Isaac 33 yrs Staff Assistant Surgeon 19 July 1825    
Lea Thomas Price   Surgeon 5th Roy Vet 23 Nov 1835 Aortic Aneurysm  
MacAdam George 44 yrs Physician 6 May 1814 Plague Gozo
Mackintosh William Henry 72 yrs 6 mths Surgeon Major 5 Sept 1890 Heart Disease Ta' Braxia
Matthew Thomas Patrick 45 yrs 4 mths Surgeon Major 8 June 1865 Pneumonia Ta' Braxia
Morrison William   Surgeon 90th 1 Feb 1824    
Odell Francis 38 yrs 8 mths Surgeon 64th 19 Aug 1870 Liver abscess Ta' Braxia
Priest Joseph   Assistant Surgeon OMD 19 May 1816 Sudden death  
Rolston Thomas   Staff Assistant Surgeon 31 Aug 1826    
Shower John   Apothecary 29 Oct 1834    
Stafford William   Surgeon 3rd Garrison 12 Feb 1816    
Thomson John Bathurst 37 yrs Surgeon 69th 18 Sept 1850 Cholera Msida Bastion
Trevor Robert 23 yrs Surgeon 15 Aug 1885   Ta' Braxia

What happened to a cohort of forty probationers who passed out of the Army Medical School at the Royal Victoria Hospital Netley on 30 January 1886 is shown in Table II. This cohort was the first to be affected by the extension of foreign service from five to six years. Forty entered Netley, but one left, reducing the group to thirty-nine. All were sent abroad within four to twelve months of obtaining their commission. Of these, all but ten were sent to India.

Table II Outcome of Medical Officers Commissioned on 30 January 1886
Name Note 1 Note 2 Note 3
Table II. Surgeons (Lieutenants) commissioned from the Army Medical School Netley on 30 Jan 1886.
Michael Thomas Yarr (1862-1937) 1st Coldstream Guards Not sent to India on commissioning DMS Malta 1917-1919
Langton Philip Mumby (1861-1903)   Not sent to India on commissioning  
Charles Henderson Melville (1863-) Sent to India on commissioning Invalided to England from India Prof of Military Hygiene 1908
Bernard Langley Mills (1861-1925)   Sent to India on commissioning  
Hugh Rayner (1860-1924) Grenadier Guards Not sent to India on commissioning  
George Schuyler Cardew (1861-1898) Sent to India on commissioning Invalided to the hills Died in India 17 Aug 1898
Richard Edward Genge (1863-1888)   Sent to India on commissioning Died in an avalanche in Kashmir 13 May 1888
Charles Alan Renny (1862-1890)   Sent to India on commissioning Died in India 23 July 1890
Herman Thiele (1858-1888)   Sent to India on commissioning Died in India 7 July 1888
William John Lee (1862-1887) Sent to India on commissioning Invalided to England. Died of Phthisis June 1887
Horace Cocks (1859-)   Not Sent to India on commissioning  
James Barnett Wilson (1862-1936 )   Sent to India on commissioning ADMS Great War
John Greer Black (1858-1914)   Sent to India on commissioning Invalided to England
John Kearney (1863-)   Sent to India on commissioning  
Frank William Hennessy (1864-1890)   Sent to India on commissioning Died in India 26 Feb 1890
Francis Albert Saw (1862-)   Sent to India on commissioning Invalided to England
Whitley Bland Stokes (1863-) Sent to India on commissioning Invalided to England Relegated to half-pay
Frederick William George Hall (1861-)   Sent to India on commissioning Invalided to England
Arthur Kennedy (1863-1936) Sent to India on commissioning Invalided to Kashmir Commanded St Patrick's Military Hospital 15 Aug 1915
George Scott Tate (1863-1889)   Sent to India on commissioning Died in India 8 July 1889
Henry William Martindale Kendall (1860-)   Sent to India on commissioning Left the services
Henry Percival George Elkington (1863-1914)   Sent to India on commissioning Stationed at Pindi. Was up on the hill station
a good many summers
Robert Charles Gordon Dill (1861-) Sent to India on commissioning Invalided to England Surgeon City of London Artillery Nov 1889
John Blacker Whitla Buchanan (1863-)   Sent to India on commissioning Invalided to England
Frederick Thomas Skerrett (1858-1899)   Sent to India on commissioning Invalided to England
Henry MacKenzie Adamson (1861-)   Sent to India on commissioning Invalided to England
Herbert Murray Ramsay (1863-1909)   Not sent to India on commissioning 14 Apr 1887 Malta
Tudor Germain Lavie (1861-1942) Sent to India on commissioning Invalided to England OC 30 Coy RAMC
James Rose (1860-1892) Sent to India on commissioning Invalided to England Relegated to half-pay
Robert Hippisley Cox (1857-) Coldstream Guards Not sent to India on commissioning Left the services
Edward Hawke Locker (1857-)   Not sent to India on commissioning  
Harry Herbert Brown (1862-1931)   Sent to India on commissioning  
Thomas Herbert Corkery (1861-1936)   Sent to India on commissioning  
Warren Roland (Davies) Crooke-Lawless (1863-)   Sent to India on commissioning  
Walter Perfect Squire (1860-)   Sent to India on commissioning  
Charles Lawrence Walsh (1864-1891)   Sent to India on commissioning Died in India 4 Aug 1891
James J O'Donnell (1861-1909)   Not sent to India on commissioning Died in India 7 Jan 1909
Stanley John Wallace Hayman (1861-1906)   Not sent to India on commissioning  
Julian Philip Swindell Hayes (1859-1930)   Sent to India on commissioning In India for only six months

Of the twenty nine medical officers who went to India in 1887, 19 survived their tour, six died, five from enteric, dysentery, or cholera and one was killed in an avalanche in Kashmir. Of the remainder, twelve had to be sent away on sick leave at different times, 11 to England and one to Kashmir. Of those sent home, two, namely Stokes and Rose, were so poorly that they were relegated to half-pay. Of the remainder, Cardew and Lavie had to be given hill stations or sick leave to the hills. Cardew returned home a perfect wreck, yet returned to India, and died there in August 1898. Lavie had to be sent home early in the season out of his turn, so as to get him out of the country. He recovered and eventually arrived at Malta. Thus of the 29 who were out in India, only 8 were able to withstand the work and the climate for six years.19

Medical Military Grades

Army medical officers had relative rank only. They had no substantive military rank. They were considered as belonging to a civil department, and hence shared the bottom of the Army List with the other civil departments of the army. Length of service and military experience counted for nothing. Their low status and poor pay caused a great deal of resentment and discontent. Substantive rank was not granted until the promulgation of The Royal Warrant of 23 June 1898, which elevated the Army Medical Department to a Royal Corps of the British Army. Until then, the Army Medical Department was split into the regimental branch and the staff branch. The medical grades of the staff were repeatedly altered by a series of Royal Warrants. Table III is a selection of medical officers prior to 1830 showing the change in rank as they progressed through their service.

Table III Progression through Medical Grades of selected officers prior to 1830
R Grieves W Franklin G Dickson A Bolton F Wells T L Bolton J Price G MacAdam J Thomas E Starkie A Broadfoot A Smith
Table III. Evolution of medical ranks and the time taken to gain promotion. Inspectors of Hospitals and their deputies were first appointed in 1798. The Royal Warrant of 22 May 1804 discontinued the ranks of Inspector of Field Hospitals (IFH), Assistant Inspector of Hospitals (AIH), Inspector General (IG) and Deputy Inspector General (DIG). Under this warrant, Assistant Inspectors of Hospitals became Deputy Inspectors of Hospitals (DIH). This rank was discontinued under the Royal Warrant of 29 July 1830 which resurrected the rank of Assistant Inspectors of Hospitals (AIH) to replace that of Physician to the Forces. The 1830 warrant reintroduced the titles of Inspector General of Hospitals (IGH) and that of Deputy Inspector General of Hospitals (DIGH). These evolved into those of Surgeon–General (SG) and Deputy Surgeon–General (DSG) by the Royal Warrant of 1 March 1873. The rank of Apothecary to the Forces was abolished by the warrant of 1830, re-established by that of 2 October 1854, and removed finally by the Royal Warrant of 1 October 1858.
1784 Surg Mate 1787 Reg Mate 1793 Reg Surg 1793 Reg Surg 1794 Reg Mate 1795 Hosp Mate 1796 Reg Mate 1797 As Surg 1800 Hosp Mate 1801 Hosp Mate 1804 Hosp Mate 1815 Hosp Mate
1789 Hosp Mate 1790 Reg Surg 1800 Purv 1796 Staff Surg 1794 Hosp Mate 1795 Reg Surg 1797 As Surg 1805 Reg Surg 1800 As Surg 1807 Apoth 1807 As Surg 1816 Hosp Assistant
1790 Staff As Surg 1794 Apoth   1802 IFH 1795 Reg Surg 1801 Apoth 1801 Dep Purv 1813 Phys 1800 Apoth   1812 Reg Surg 1825 As Surg
1794 Reg Surg 1796 AIH   1804 DIH 1801 Apoth 1803 Gar Surg 1807 Staff Surg   1800 Garr Surg   1820 Staff Surg 1826 Staff Surg
1801 Staff Surg 1800 DIGH     1807 Reg Surg   1810 Phys   Gar Surg 1805   1826 DIH 1837 Staff Surg 1st Class
1806 DIH 1802 IGH             Dep Insp Hosp 1825     1845 DIGH
1816 IGH 1830 IGH                   1851 IGH

The regimental medical grades were:

  1. Surgeons' Mate (1673–(1796 became Assistant Surgeons)
  2. Assistant Surgeons (1796–(1873 became Surgeons )
  3. Surgeons (1660–(1873 became Surgeons-Major)
  4. Surgeons-Major (1858 surgeons after 20 yrs fp, 1873–(1898 became Majors)

The relative ranks of Surgeons-Major, Surgeons, and Assistant Surgeons, were fixed by the Royal Warrant of 27 September 1860. The Surgeon Major ranked as Lieutenant Colonel, the Surgeon as Major, and the Assistant Surgeon over six years service as Captain and those under 6 years service as Lieutenant.

By 1684, every regiment of infantry had a Surgeon and a Surgeon's Mate or Regimental Mate. The Mate was a warrant officer. Their professional training was one of apprenticeship to an apothecary. Some were better qualified, having attended courses of clinical lectures. Their low status and poor pay of 2s 6d a day deterred applicants. In 1759, the pay of the Mate was raised to 3s 6d. The outbreak of war with France in 1793, gave regimental mates the opportunity to buy regimental commissions. Others became Hospital Mates, as this rank offered them better pay. The Royal Warrant of 30 November 1796, made the regimental mate a commissioned officer with the title of Assistant Surgeon. It increased his pay to 5 shillings in peace and 7s 6d during war. Assistant Surgeons had the equivalent rank of Subalterns for allowances. In September 1803, a second Assistant Surgeon was appointed to regiments with over 500 men; on 27 April 1826 another was added to regiments deploying to India. The Royal Warrant of 1 October 1858 obliged Assistant Surgeons to sit for an examination for promotion to surgeon. In addition, they had to serve 5 years on full-pay, of which two years had to be in the rank of Surgeon, before becoming eligible for promotion. The Royal Warrant of 1 March 1873 abolished the rank of Assistant Surgeon and replaced it with that of Surgeon. The relative rank was Lieutenant, rising to Captain after six years' service.

Regimental Surgeons were promoted from the ranks of Assistant Surgeons or from the staff. The Royal Warrant of 30 November 1796 gave them the relative rank of captain. The Royal Warrant of 22 May 1814 gave them a pension of 5 shillings a day on completion of twenty years' service, which was increased to twenty five years' service by the warrant of 14 October 1840. This warrant stipulated that surgeons had to serve ten years on full-pay, before promotion. The Royal Warrant of 1 October 1858, promoted surgeons who had served for more than 20 years full-pay service, to the new rank of Surgeons-Major. However every surgeon was raised to the rank of Surgeon Major by the Royal Warrant of March 1873. Their relative rank was now that of Major, rising to Lieutenant Colonel after twenty years' service.

Table IV Schedule of Pay granted by the Royal Warrant of 22 May 1804
(Superseded by RW of 29 July 1830)
Rank Daily Pay Daily
Half-pay
Note
Table IV The Royal Warrant of 30 Nov 1796 increased the pay of the regimental surgeon from 4 shillings to 10 shillings a day. That of 22 May 1804, increased it even further to 11s 4d a day rising to 14 shillings a day on completion of seven years' service. (From T Graham Balfour Appendix XIII p 409, Appendix to evidence taken before the commission appointed to inquire into the regulations and sanitary conditions of the army.)
Hospital Mate (Home) 6s 6d 2s  
Hospital Mate (Abroad) 7s 6d 2s  
Assistant Surgeon (Cavalry) 8s 6d 3s Extra 1s for the expense of keeping a horse
Assistant Surgeon (Infantry) 7s 6d 3s In 1763 the pay of the Mate was increased
from 2s 6d to 3s 8d a day
Apothecary to Forces 10s 5s Surgeons of recruiting district received the
same pay as the Apothecaries
Regimental Surgeon 11s 4d 6s On appointment
Regimental Surgeon 14s 1d 6s After 7 yrs' service as surgeon or
After 10 yrs' service in army
Regimental Surgeon 18s 10d 6s After 20 yrs' service in army
Regimental Surgeon 18s 10d 10s If retired from ill health after 20 yrs' service
Regimental Surgeon 18s 10d 15s After 30 yrs' army service was entitled to
retire even if in good health
Surgeons to the Forces 15s 6s After 20 yrs and 30 yrs' service had the
same increase rate of pay as
regimental surgeons
Physician to the Forces £1 10s  
Deputy Inspector General of Hospitals £1 5s 12s 6d  
Deputy Inspector General of Hospitals £1 10s 15s After 20 yrs' service
Inspector General of Hospitals £2 £1  
Principal Inspector £2   Member Army Medical Board
Surgeon–General £2   Member Army Medical Board
Physician General £2   Member Army Medical Board

Medical staff were either administrative or executive officers. Those who treated patients, such as Staff Assistant Surgeons and Staff Surgeons of the 2nd Class, carried an executive grade; the rest, who were not commissioned to any particular regiment, saw no patients, and did administrative work only, pertained to the administrative class. Staff Medical Officers of the lower grade attended at the station hospital, inspected all recruits joining the garrison, examined recruits for the mark of small pox vaccination, carried out sanitary inspections, furnished medical attendance to officers and their families and to soldier's wives and their children, sat on medical boards, and inspected all embarking and disembarking troops for the presence of venereal diseases.

The staff grades were:

  1. Deputy Purveyor (1798-1830)
  2. Purveyor (1690-1830, 1853)
  3. Apothecary to the Forces (1673-1830, 1854-(1858, grade abolished)
  4. Physician to the Forces (1661-(1830, replaced by that of Assistant Inspector of Hospitals)
  5. Commissioned Hospital Mate (1804-1813, became Hospital Assistant to the Forces)
  6. Hospital Assistant to the Forces (1813-(1830, became Staff Assistant Surgeon)
  7. Inspector General of Hospitals (1795-(1804, reintroduced in 1830)
  8. Inspector of Army Hospitals (1804-1830)
  9. Assistant Inspector of Hospitals (1795-1804, 1830-(1840 rank abolished)
  10. Deputy Inspector of Hospitals (1804-1830 reintroduced in 1830)
  11. Inspector General of Hospitals (1830-(1873 became Surgeon-General)
  12. Deputy Inspector General of Hospitals (1830-(1873 became Deputy Surgeon-General)
  13. Staff Surgeon (1790-(1840 divided into 1st and 2nd classes)
  14. Staff Assistant Surgeon (1830-1873)
  15. Staff Surgeon 1st Class (1840-1858)
  16. Staff Surgeon 2nd Class (1840-1858)
  17. Staff Surgeon (1858-1873)
  18. Surgeon Major (1858, 1873-1898)
  19. Brigade Surgeon (1879-1891 New rank introduced under RW of 1879)
  20. Deputy Surgeon–General (1873-1891)
  21. Surgeon–General (1873-1891)
  22. Surgeon-Lieutenant (1891-1898) - up to three years' service
  23. Surgeon-Captain (1891-1898) - from three to twelve years' service
  24. Surgeon Major (1891-1898) - from twelve to twenty years' service
  25. Surgeon-Lieutenant Colonel (1891-1898) - after twenty years' service
  26. Brigade Surgeon-Lieutenant Colonel (1891-1898) - on promotion
  27. Surgeon-Colonel (1891-1898) - on promotion
  28. Surgeon Major-General (1891-1898) - on promotion

Hospital Mates were the most junior of the staff. From 1798, Mates were appointed by the Inspector of Regimental Hospitals on the recommendation of the Surgeon-General. The Royal Warrant of George III, dated 22 May 1804, recognised two classes of Hospital Mates, a commissioned Hospital Mate for General Service, and a Hospital Mate for Temporary or Local Service, appointed by warrant. Warrant Hospital Mates were not eligible for a commission until they gained further qualifications. Hospital Mates appointed by commission had to pay £4 19s 6d in fees. The sum was deducted from the amount of pay issued in advance to such as embarked from the Isle of Wight.35 In 1813, all medical officers proceeding to the Army Depot reported to the Inspector of Hospitals Isle of Wight. The young officers were attached to the General Hospital and instructed in their duties under the direction of the Principal Medical Officer.

On 8 June 1813, Commissioned Hospital Mates became Hospital Assistant to the Forces, while those appointed by warrant retained the term Hospital Mates. The Royal Warrant of William IV, dated 29 July 1830, made him a Staff Assistant Surgeon, and placed a time-bar of seven years' service before promotion to Staff Surgeon. In March 1873, Assistant Surgeons became Surgeons with the relative rank of Lieutenants.

Staff Surgeons were usually promoted from the ranks of Hospital Mates, Regimental Surgeons, and Apothecaries. The Royal Warrant of 29 July 1830, laid down a period of 10 years' service on full-pay before becoming eligible for promotion. From 1830 onwards, only those who had served as regimental surgeons had the right to be appointed to the staff. Staff Surgeons were liable to be sent hither and thither to any corner of the globe, whenever additional medical aid was required. They stood in for the sick regimental surgeon, covered ports of disembarkation when these became overwhelmed by a large influx of invalids, and were deployed to shore up the medical staff in the colonies hit by epidemics of plague or cholera.

The Royal Warrant of 14 October 1840, created the ranks of Staff Surgeon of the First Class, and Staff Surgeon of the Second Class. Staff Surgeons of the Second Class were executive officers. They were the equivalent of the regimental surgeons, serving on the staff. They had the equivalent rank of Captain. Staff Surgeons of the First Class came in as junior administrative officers to replace the rank of Physician to the Forces and Assistant Inspectors. The latter assumed that because they were called Physicians, they would do nothing but Physicians' duty. Therefore, when the opportunity arose to revise the different departmental grades, it was proposed to merge them into Staff Surgeons of the First Class, with the equivalent rank of Major. They were posted to small stations, such as Malta, which did not merit an administrative officer of the rank of Deputy Inspector of Hospitals. Staff Surgeons First Class had to serve three years at Home or two years abroad before they were considered for promotion. The Royal Warrant of 1 October 1858, simplified all the ranks of surgeons into either Regimental or Staff. In 1858, surgeons who had served for more than 20 years in any rank, became Surgeons-Major, with the equivalent rank of junior Lieutenant Colonel. Regimental or Staff Surgeons by the warrant of 1858, had to serve ten years' service, two in the rank of surgeon, before being allowed to proceed to a higher rank.

Inspectors General of Hospitals were appointed in 1795 as administrative officers. In 1804 the title changed to Inspectors of Army Hospitals. The Royal Warrant of William IV, dated 29 July 1830, reintroduced the rank of Inspector of Hospitals, but added the additional title of General. Those serving as Inspector of Hospitals became Inspector General of Hospitals, and those with the rank of Deputy Inspector of Hospitals became Deputy Inspector General of Hospitals. The Inspector General was the professional advisor to the Divisional General. He collected reports, inspected hospitals, superintended sanitary arrangements, sat on boards where medical knowledge was required, kept his subordinates in good working order, and checked all waste and expenditure.

Assistant Inspectors of Hospitals were introduced in 1795 to give experienced Staff Surgeons a step in promotion. These ranked below the Physicians to the Forces. Under the authority of the Royal Warrant of George III, dated 22 May 1804, Inspector of Army Hospitals Francis Knight replaced the rank of Assistant Inspector of Hospitals with the new administrative rank of Deputy Inspectors of Hospitals. Deputy Inspectors of Hospitals ranked above physicians. The patronage of these appointments lay with Knight, who made it a rule to appoint none other than surgeons to these posts.24

The Royal Warrant of 1 March 1873, abolished the ranks of Inspector General of Hospitals and Deputy Inspector General of Hospitals, substituting them with those of Surgeon-General, and Deputy Surgeon-General respectively. A Surgeon-General ranked as Brigadier General, and a Major General after three years' service in the rank. A Deputy Surgeon-General ranked as Lieutenant Colonel, and Colonel after five years' service in the rank. The Royal Warrant of 28 April 1876 altered their relative ranks to Major Generals and Colonels.

Physicians bypassed the lower grades altogether and came in above the surgeons as Physician to the Forces. Physician General Sir Lucas Pepys would not recommend anyone to the rank of physician, unless he was a member of an English University, or of the London College of Physicians. Thus in 1808, Arthur Brooke Faulkner was commissioned Physician to the Forces on the strength of his academic qualifications alone, without any further proofs of his competency. Brooke Faulkner had graduated Bachelor of Arts from Trinity College Dublin in 1800, and MD Edinburgh in 1803. He spent two years at the London Hospital, the Westminster Hospital and the Surrey Dispensary, and had taken a degree in Physic at the University of Oxford and an MA at Cambridge. In 1808, he was admitted Fellow of the Royal College of Physicians. He thus had all the right academic qualifications but lacked military experience.

Staff Surgeons were justified when they complained that "Any inexperienced young Englishman, though only just emerging from study, and merely possessing the all sufficient talisman of a Doctor's or even a Bachelor's degree in physic, or above all, upon his becoming a member of the London College, was at once deemed professionally eligible to a commission. Those who chose not to pay the admittance fee of 50 guineas into the London College of Physicians, or were not graduates of Oxford or Cambridge were excluded, irrespective of the vast experience they had accumulated through service in the Indies".24

The monopoly held by the physicians was gradually eroded. The Royal Warrant of 12 March 1798, allowed graduates from any university in Great Britain to be eligible for the commission of Physician to the Forces, provided they were found qualified by a Board comprising the Physician General and two army physicians. From 29 July 1811, regimental and Staff Surgeons who held the degree of MD were allowed to become physicians. The Royal Warrant of 29 July 1830, abolished the rank of Physician to the Forces and re-introduced the designation of Assistant Inspector of Hospitals. The latter was once again dispensed with by the Royal Warrant of 14 October 1840.

The Apothecary to the Forces was responsible for the care and issue of medical stores. The Royal Warrant of 12 March 1798, permitted Assistant Surgeons and Hospital Mates to become apothecaries. The Royal Warrant of 29 July 1830 abolished the rank of Apothecary to the Forces, but apothecaries were re-established by the Royal Warrant of 23 October 1854. They ranked as Lieutenants for the first 15 years of their service, and as junior Captains thereafter. They received 9 shillings a day on appointment. These new Apothecaries held the Certificate of the Apothecaries Hall in conformity with The Apothecaries Act of 1815. This required all candidates for a licence to have served an apprenticeship to an apothecary for not less than five years and could produce testimonials of a sufficient medical education and good moral conduct. As they were better educated then their predecessors, they were unlikely to submit to the status of merely being dispensers to surgeons or store keepers. The rank of Apothecaries was abolished by the Royal Warrant of 1 October 1858 when some of the apothecaries took up the post of Officers of Orderlies in the Army Hospital Corps.

The Purveyor provided the supplies and diets to the General Hospitals. They kept a check upon extravagance, mainly the extras in the diets prescribed for the patients by medical officers. At first Purveyors were taken from medical officers whose rate of pay did not exceed 10 or 12 shillings per day, as laid down in the Royal Warrant of 1798 when Thomas Keate became Surgeon–General. Purveyors were taken from medical men as a step to promotion, but, seeing the inconvenience of it, Keate recommended they should in future be selected from persons versed in accounts, without reference to medical knowledge. The Fifth Report of the Commissioners of Military Inquiry of 1808, regarded Purveyors as mere storekeepers and stewards, and recommended their pay to be reduced if the rank was no longer regarded as a step in promotion for medical officers.

The Purveyor's department was suppressed in July 1830 as a measure of economy. The Purveyors were pensioned off but the existing Deputy Purveyors continued to discharge their functions, though it was intended that eventually the office would be abolished. On 27 April 1853, the department was re-established, partly with a view to check the expenditure, and partly to prevent a considerable amount of small peculation which had existed in the regimental and garrison hospitals, where no Purveyors were stationed, and where the hospital sergeants provisioned their hospitals.

In 1853, the whole of the army at home was under the system of Purveyors under the title of Deputy Purveyors. It was therefore determined to recognize the department as an existing branch of the army. This was done to relieve the surgeons of direct financial responsibilities and to maintain a stricter control of the accounts. The supplies of the hospitals were taken away from the regimental surgeons at the same time as the accounts, so as to give them more uninterrupted time for purely professional duties. In 1856, Lord Panmure decided that the purveying system should be extended to the colonies and that there should be Purveyors throughout the army.

The Royal Warrant of 31 October 1855 established five ranks of Purveyors: Purveyor-in-Chief, Deputy Purveyor-in-Chief, Purveyors, Purveyor's Clerks 1st Class, and Purveyor's Clerks 2nd Class. Only the first three were commissioned officers. They had the relative rank of Major, Captain and Lieutenant respectively.

The Royal Warrant of 27 November 1879 introduced the new rank of Brigade-Surgeon, a grade between the senior Surgeon Major and the Deputy Surgeon–General. The relative rank was that of Lieutenant Colonel. Brigade Surgeons were selected for their ability and merit from the Surgeons Major, provided they had served abroad at least eight years in the rank of Surgeon Major and Surgeon. Deputy Surgeons-General were selected from the Brigade-Surgeons who had served ten years abroad including three years in India. Surgeons-General were selected from the Deputy Surgeons-General for ability and merit.

In March 1890, the Secretary of State for War, Edward Stanhope, published the report of the Earl of Camperdown Committee on the pay and status of medical officers of the army and navy. The committee did not recommend the granting of military titles. "We are of opinion that no good reasons have been given for conferring pure military titles on medical officers. Such would be displeasing to a large number of army medical officers, and to the general feeling of those in the navy. We think, too, that it is essential for the dignity of the Army Medical Service that it should plainly appear that they are members of their eminent profession. A compound title, up from Surgeon-Lieutenant to Surgeon-General, is recommended, the titles of Brigade-Surgeon and Deputy Surgeon-General being merged respectively into Surgeon Lieutenant Colonel and Surgeon-Colonel".18

The new grades were promulgated by the Royal Warrant of 7 August 1891. Camperdown recommended that the first fifty Surgeons-Lieutenant Colonels should have the pay and allowances of Brigade-Surgeons, while those not in the first fifty on the list, were to retain their right to retire after twenty years' service. Medical officers were given relative army rank as expressed in their titles, from Lieutenant to Major General. Surgeons-General ranking as Major Generals became Surgeons-Major General, Deputy Surgeons-General ranking as Colonels became Surgeons-Colonel, Brigade Surgeons ranking as Lieutenant Colonels became Brigade Surgeons-Lieutenant Colonels, Surgeons-Major ranking as Lieutenant Colonels became Surgeons-Lieutenant Colonels, Surgeons-Major ranking as Majors became Surgeons Major, and Surgeons ranking as Captains became Surgeon Captains. Surgeons were to hold the rank of Lieutenant for the first three years of service. The rank of Brigade-Surgeon-Lieutenant Colonel, was reached after over 26 years service, when the officer was about 49 to 50 years of age. That of Surgeon Colonel, was not arrived at till the officer was 55 years old.

On 23 June 1898, medical officers in the newly raised Royal Army Medical Corps received substantive rank. Under this warrant, their ranks were altered from Surgeons-Colonel to Colonels, Brigade Surgeon-Lieutenant Colonel and Surgeon-Lieutenant Colonel to Lieutenant Colonels, Surgeons Major to Majors, Surgeon Captains to Captains, and Surgeons Lieutenant to Lieutenants. By the Royal Warrant of 9 January 1907, Colonels no longer remained officers of the RAMC, and were transferred to the Staff.

Army Service — Promotion

Medical officers complained that it took them too long to get promoted. They were also never aware when they were due promotion, as their position in the Army List was not always honoured. The rules governing promotion were seniority and selection, but medical officers were promoted out of turn for distinguished service in the field. Confidential reports had a bearing on promotion. Thus, Staff Assistant Surgeon Thomas Patrick Matthew had an increased chance for promotion on the strength of a confidential report which declared him to be "a first rate anatomist and operative surgeon, one of sound discrimination and excellent character".30 In October 1855, Inspector General Sir John Hall had recommended him for promotion to the rank of Staff Surgeon. Hall, described Matthew as "a first rate surgeon, who would do credit to the appointment; he had performed his duties in a most satisfactory manner".30 Compare this report with that of Brigade-Surgeon-Lieutenant Colonel Henry Thomas Brown who was censured by the Director General for not examining troops on board ship for venereal disease. Brown failed to give a satisfactory explanation with regard to cases of venereal disease found subsequent to disembarkation amongst a draft from the 1st/Royal Lancashire Regiment at Malta, when he was in medical charge of the voyage from Bombay. The Director General expressed regret that the breach of duty was committed by an officer of his standing and antecedents. Blotting one's record was unlikely to get one promoted.31 Promotions followed the creation of vacancies. Table V shows the established strength of the Army Medical Department in 1857. Table VI gives the number of vacancies arising between 1839 and 1854 as a result of deaths in service.

Table V Rank and Number of medical officers on 1 April 1857
On Full Pay half-pay and Retired Pay 3
Medical Grade Full Pay half-pay Retired Pay
In 1857 there were 727 officers, of which 440 were part of regiments as Surgeons and Assistant Surgeons. The rest were Staff Medical Officers. A certain proportion of Staff Medical Officers were senior officers serving on foreign stations and also on home stations as PMOs. A certain number of Staff Surgeons were doing executive duties, the remainder of the Staff Surgeons and Assistant Surgeons were distributed according to the need of the service. The Ordnance Medical Department amalgamated with the AMD in 1853.
Director General AMD     1
Principal Inspector General AMD     1
Inspector General of Hospitals 6 1 20
Deputy Inspector General of Hospitals 17 3 19
Assistant Inspectors of Hospitals (Physician to the Forces)     4
Surgeons to the Forces prior to RW 2 July 1841     28
Staff Surgeon 1st Class 30 20 29
Staff Surgeon 2nd Class 70 18 131 (inc reg surg)
Staff Assistant Surgeon 138    
Regimental Surgeon 145    
Assistant Surgeon 254 2 34
Deputy Inspector General of Hospitals (Ordnance Medical Department) 1    
Senior Surgeon (OMD) 4    
Surgeons (OMD) 17    
Assistant Surgeons (OMD) 45    
Table VI Medical officers On full pay and deaths in service from 1 April 1839 to 31 March 1854
Period Medical Officers
On Full Pay
Deaths in Service Deaths per 100 strength
Medical officers on full pay and deaths in service from 1 April 1839 to 31 March 1854
1 Apr 1839 - 31 Mar 1840 496 24 4.8
1 Apr 1840 - 31 Mar 1841 501 15 2.9
1 Apr 1841 - 31 Mar 1842 508 15 2.9
1 Apr 1842 - 31 Mar 1843 533 30 5.6
1 Apr 1843 - 31 Mar 1844 546 23 4.2
1 Apr 1844 - 31 Mar 1845 524 16 3.1
1 Apr 1845 - 31 Mar 1846 540 13 2.4
1 Apr 1846 - 31 Mar 1847 538 17 3.2
1 Apr 1847 - 31 Mar 1848 579 12 2.1
1 Apr 1848 - 31 Mar 1849 568 17 2.9
1 Apr 1849 - 31 Mar 1850 573 16 2.8
1 Apr 1850 - 31 Mar 1851 566 20 3.5
1 Apr 1851 - 31 Mar 1852 559 20 3.6
1 Apr 1852 - 31 Mar 1853 563 17 3.0
1 Apr 1853 - 31 Mar 1854 566 22 3.8

Once a vacancy occurred, it was assumed that the next senior on the Army List would automatically get promoted. This was, however, not assured. A senior who was ill when a vacancy arose was invariably passed over until a medical board declared him fit; if the vacancy occurred as a result of death of the incumbent, the next senior in that group of stations where the vacancy occurred got the post. This rule was brought in as the Treasury would not pay the passage of an officer from England. Thus, to enable regiments to remain fully established, the next senior in the station was elected to the vacancy. An officer only arrived from outside the group of stations if a vacancy occurred from retirement, when the next on the list embarked on the transports in medical charge of the draft of soldiers sent out to the colonies. For promotion purposes, Malta formed part of the Mediterranean Group, which included Gibraltar and the Ionian Islands. The American Group consisted of Canada, Nova Scotia and Bermuda; the Cape of Good Hope Group incorporated the Cape of Good Hope and Mauritius; and the Australian Group comprised New Zealand, New South Wales and Van Diemen's Land.

Moving on was important as a higher rank was reflected in a larger pension. Royal Warrants which regulated their pay and allowances laid down the number of years an officer had to serve before he entered the zone for promotion. The Royal Warrant of 1 October 1840, for instance, laid down that an Assistant Surgeon had to served on full pay five years before he became eligible for the rank of regimental surgeon, or of Staff Surgeon Second Class; Regimental Surgeons and Staff Surgeons of the Second Class had to have served ten years in the army on full pay before they moved on to the next step. A Staff Surgeon of the first class had to serve three years at home, or two years abroad, in this rank, before he was eligible for promotion. A Deputy Inspector General of Hospitals had to have served five years at home, or three years abroad, in this rank, before he was eligible for promotion to the highest rank of Inspector General.

Once they completed their required "years in rank", whether they actually moved on or not, depended very much on the presence of a free slot for them to move into. Promotion was assured and rapid during war when newly raised regiments needed their new complement of doctors, and battle casualties had to be replaced. In peace time, however, vacancies only occurred if the incumbent resigned his commission, was dismissed by a sentence of a Courts Martial, was relegated to half-pay, died in office, or if he in turn moved up to a vacant rank. Because promotion was linked to the availability of vacancies, the lower ranks were unable to move up until the higher ranks retired.

Officers had the right to retire after completing twenty years' service. Those with large families to educate and maintain were reluctant to go on half-pay, and tenaciously remained in office in the hope of being promoted to a higher rank and a better pension. There was thus a great degree of discontent among senior Assistant Surgeons who still occupied the same rank after fourteen years' service or more. Assistant Surgeons could not comprehend why the veteran surgeon of twenty five years' service did not leave, as entitled to, on their full pension of one pound per day. They were unable to sympathize with these elderly gentlemen who hang on until they attained the compulsory retirement age of fifty-five, in the hope of obtaining one of the deputy-inspectorships, which once secured, allowed them to stay on for the extra ten years they were permitted to hold them. The retiring age of Surgeons-General and Deputy Surgeons-General was lowered to sixty years by the Royal Warrant of 28 April 1876. The only way to accelerate promotion and remove discontent among the lower grades was to offer financial inducements for the higher ranks to enable them to leave on a substantial pension.

Promotion also depended upon passing requisite examinations. Formerly, promotion from Assistant Surgeon to the rank of Surgeon depended on passing a second examination to ensure that the Assistant Surgeon had attained a certain standard of proficiency. The examination was discontinued owing to its unpopularity among those subjected to it, who considered it derogatory to men of their standing. In the absence of an examination the Director General relied on seniority in the service and annual reports to promote Assistant Surgeons to Surgeons. The 1858 Commission chaired by Sidney Herbert recommended the re-introduction of examinations for promotion. No time was granted to medical officers to prepare themselves for promotion, as the Treasury would not foot the bill of bringing officers home from the colonies, and to send out replacements. It was considered harsh to deny promotion to a surgeon who had worked hard for fifteen years with his regiment just because he was unable to pass an examination. Officers were so often abroad that it was difficult to spare them the time or expense to return them to England to study. Examination for promotion from Surgeon to Surgeon Major were discontinued by the Royal Warrant of April 1876. The warrant of November 1879, reinstated the examinations for promotion from Surgeon to Surgeon Major and from Surgeon Major to Brigade-Surgeon, However, the Camperdown Committee of 1890 abolished the examinations for promotions above the rank of Surgeon Major, and recommended that promotion to the ranks of Brigade-Surgeon Major and Deputy Surgeons General should occur by selection.

Army Service Pay — Pension — Retirement

The pay of medical officers was regulated by a number of Royal Warrants which pegged it to their rank and length of service. They often received less pay than the warrants prescribed, as different regulations applied to administrative officers (staff), and executive officers (regimental). Regimental officers had far greater expenses than Staff Medical Officers but received no higher pay. For a married officer with a family, this differential in pay represented a significant loss of income.

The Royal Warrant of 1 March 1873 transformed every regimental officer into a departmental officer. However, when they were attached to regiments for a period of five years, the authorities regarded them as regimental officers and imposed mess charges. According to the warrant of 1873, medical officers were entitled to all the precedence and advantages of their rank, with the exception of military command. Relative rank regulated choice of quarters, rates of lodging money, fuel and light, servants, as well as allowances granted on account of wounds or injuries received in action, and pensions and allowances to widows and families. However, through Army Circular of 1 August 1870, the allowance for fuel and light in a regiment was only allowed to one Lieutenant Colonel, the officer commanding. A second Lieutenant Colonel in a regiment, whether holding that rank by brevet or otherwise, was only allowed the allowances of a Major or field officer. Thus, the medical officer with the relative rank of Lieutenant Colonel who was attached to a regiment lost out on a significant income, whereas the staff medical officer of Surgeon Major grade, who held the same relative rank, if not attached to a regiment, drew the allowances laid down for a Lieutenant Colonel.32

Table VII Royal Warrant of William IV regulating the Daily Rate of full pay dated 29 July 1830
Rank > 25 yrs > 20 yrs < 25 yrs > 10 yrs < 20 yrs < 10 yrs
The RW 1830 abolished the ranks of Apothecary to the Forces and of Hospital Assistant. That of Physicians to the Forces changed into Assistant Inspector of Hospitals.
Inspector General of Hospitals £2 £1 18s £1 16s  
Deputy Inspector General of Hospitals £1 10s £1 8s £1 4s  
Assistant Inspector of Hospitals £1 4s £1 2s 19s  
Staff Surgeon £1 3s £1 16s 14s
Regimental Surgeon £1 2s 19s 15s 13s
Assistant Surgeon 10s 10s 10s 7s 6d
Table VIII Warrant regulating half-pay dated 29 July 1830 (USJ 1830 part II p 624-629)
Rank Rates of half-pay for reduced officer
(Reduction of regiment)
After service on full pay of
Rates of half-pay for retired officer
(Reduction other causes)
After service on full pay of
  30 yrs >25 yrs
< 30 yrs
>20 yrs
< 25 yrs
>10 yrs
< 20 yrs
< 10 yrs 30 yrs >25 yrs
< 30 yrs
>20 yrs
< 25 yrs
>10 yrs
< 20 yrs
< 10 yrs
Rates of half-pay RW 22 July 1830. Staff and regimental surgeons after 20 yrs service on full pay were entitled to 10 shillings a day half-pay if retired on ill health, by former warrants. The RW of 1830 did not take ill health on retirement into consideration.
IGH £1 10s £1 5s £1     £1 15s 12s    
DIGH £1 17s 14s 10s 6d 8s 18s 14s 10s 8s 7s
AIH 17s 15s 12s 6d 10s 7s 6d 16s 13s 9s 6d 7s 6d 6s 6d
Staff Surg 16s 14s 12s 9s 6d 7s 15s 12s 9s 6s 6d 6s
Reg Surg 15s 13s 11s 8s 6d 7s 15s 11s 6d 8s 6s 5s 6d
As Surg 7s 6d 7s 6s 5s 4s 7s 6s 5s 4s 3s

On appointment to a regiment, every officer had to pay regimental subscriptions. An Order from Horse Guards dated 16 February 1829, laid down that every officer on appointment to a regiment had to contribute 30 days' pay, and an annual sum not exceeding 8 days' pay in support of mess contingencies. In addition twenty days' pay for the band fund on appointment, and an annual subscription not exceeding 12 days' pay in support of band expenses were deducted. The surgeon's contribution was clarified in a circular dated Horse Guards 6 April 1829. This directed that on appointment officers who were entitled to an increase in pay from length of service were not to be charged their subscriptions at that increased rate, but were only to pay at the lowest scale. A surgeon therefore had to to pay no more than 30 days' pay at 11s 4d on account of the mess fund. His annual contribution, however, was governed by the rate of pay actually received by him at the time, so that his subscription to the band and mess cost him 18s 10d a year.34

Table IX Royal Warrants 1 Oct and 14 Oct 1840 (confirmed by that of 6 Oct 1854)
Established the following rates of full pay and half-pay
Rank Daily Pay Daily half-pay Years in Rank for Promotion
    Reduction of
Establishment
Other causes  
"On promotion, an officer was only entitled to claim the full rate of pay for his aggregate length of service in all ranks if he had served 12 mths on the lowest rate of pay of his new rank. If he had equal or higher pay in the former rank, his rate of pay was that next above his former pay. A medical officer had the right to retire upon half-pay after 25 yrs actual service. If placed on half-pay by reduction of the establishment, he was recommended for the rate assigned to his rank and service provided he had served 3 yrs in the rank from which he retires. But if he had not served for 3 yrs in the rank from which he retired, he received only the rate attached to the rank from which he was last promoted. If he had served 30 yrs on full pay, including 3 yrs in the rank from which he retired, or not having served such 3 yrs, had served 10 in the colonies or 5 with the army in the field in any rank, he was allowed the higher rank of half-pay." (DG Andrew Smith AMD July 1857)
Assistant Surgeon (< 10 yrs service) 7s 6d 4s 3s Must have served 5 yrs on full pay before
being considered eligible for promotion
Assistant Surgeon (>10 yrs < 20 yrs) 10s 5s 4s  
Assistant Surgeon (>20 yrs < 25 yrs) 10s 6s 5s  
Assistant Surgeon (>25 yrs < 30 yrs) 10s 7s 6s  
Assistant Surgeon (>30 yrs service) 10s 7s 6d 7s  
Regimental Surgeon (< 10 yrs full pay) 13s 6s 5s 6d Must have served 10 yrs on full pay before
being considered eligible for promotion
Staff Surgeon 2nd Class (< 10 yrs full pay) 13s 6s 5s 6d Must have served 10 yrs on full pay before
being considered eligible for promotion
Regimental Surgeon (>10 yrs < 20 yrs fp) 15s 8s 6d 6s  
Regimental Surgeon (>20 yrs < 25 yrs fp) 19s 11s 8s  
Regimental Surgeon (>25 yrs < 30 yrs fp) £1 2s 13s 11s 6d  
Regimental Surgeon (>30 yrs full pay) £1 2s 15s 15s  
Staff Surgeon 1st Class (< 10 yrs fp)   7s 6d 6s 6d Must have served 3 yrs at home on full pay
or more than 2 yrs abroad in this rank before
being considered eligible for promotion
Staff Surgeon 1st Class (>10 yrs < 20 yrs fp) 19s 10s 7s 6d  
Staff Surgeon 1st Class (>20 yrs < 25 yrs fp) £1 2s 12s 6d 9s 6d  
Staff Surgeon 1st Class (>25 yrs < 30 yrs fp) £1 4s 15s 13s  
Staff Surgeon 1st Class (>30 yrs on fp) £1 4s 17s 16s  
Deputy Inspector General of Hospitals (< 10 yrs)   8s 7s Must have served 5 yrs at home or
3 yrs abroad in this rank before
being considered eligible for promotion
Dep Insp Gen of Hosp (>10 yrs < 20 yrs fp) £1 4s 10s 6d 8s 5 yrs at home After 3 yrs abroad in this rank
Dep Insp Gen of Hosp (>20 yrs < 25 yrs fp) £1 8s 14s 10s  
Dep Insp Gen Hosp (>25 yrs < 30 yrs fp) £1 10s 17s 14s  
Deputy Insp Gen Hosp (>30 yrs full pay) £1 10s £1 18s  
Inspector General of Hospitals (>10 yrs < 20 yrs fp) £1 16s      
Inspector General of Hospitals (>20 yrs < 25 yrs fp) £1 18 s £1 12s  
Inspector General of Hospitals (>25 yrs < 30 yrs fp) £2 £1 5s 15s  
Inspector General of Hospitals (>30 yrs full pay) £2 £1 10s £1  

Surgeons had to buy their own set of surgical instruments, pay for their own uniforms, lodging and travel. On embarkation a surgeon had to pay for his rations at the rate, in 1814, of 3d a day. Thus, when Gavino Patrizio Portelli sailed for Malta from Portsmouth on the Dartmouth transport on 20 September 1814, he had to pay 9s for 36 day passage for rations on board ship. A surgeon of an infantry regiment was subject to an additional deduction of eight and a half pence per day from his pay for the forage he received for his horse. A forage allowance was eventually granted in the Royal Warrant of 1858. This was withdrawn by the Royal Warrant of 1 March 1873, but reinstated by the supplement to the warrant of 23 October 1873, only for medical officers whose duties required them to have a horse. A young man with no private means was totally incapable of meeting the expenses of a guards or cavalry regiment where he had to provide for himself the uniform, all the accoutrements, and meet the cost of mess guests and port and wine at mess table.

Heavy financial losses were incurred by regimental officers following the promulgation of the unification warrant of 1 March 1873. In many cases they had paid hundreds of pounds for succession to regimental appointments, which prior to the warrant, would have been repaid to them by their successors. The case of an Assistant Surgeon who had been posted to India on the staff soon after being commissioned, illustrates the outlay involved. In India, this particular officer was gazetted to a regiment, with which he served until the regiment returned to England. Without being consulted as to his wishes, he was removed from his regiment, and found himself for the second time on the staff. Having suffered severely from the Indian climate, and reluctant to return to India as a Staff Assistant Surgeon, he obtained official sanction to exchange to a regiment which had just returned from that country. His prospects under the old system were clearly defined, as he would have been allowed to remain with his regiment until promoted, unless he moved at his own request. The regiment to which he exchanged had a long tour of home service before it, and the Assistant Surgeon had to pay a proportionately high price for the advantages he thus appeared to have secured.

His removal to the Army Medical Department by the warrant of 1873 incurred him the pecuniary loss of: (i) the compulsory band and mess entrance donations of £50 (ii) his regulation annual band and mess subscription amounting to £10 (iii) his compulsory change of uniform on moving from regiment to staff on two occasions costing him not less than £30, and a heavy tailor's bill incurred by his final removal to the staff. His greatest loss, besides the confiscation of the large sum paid for his exchange, was his deprivation of all the advantages which he had hoped to obtain by his exchange, and which he had thought he had secured, but for the 1873 warrant.32

Table X Medical Officers' Expenses in the 1870s
Expenditure £. s. d.
Pay of £302 and expenditure of £225 left a married officer the sum of £77 a year to feed, clothe, and pay all other expenses connected with his family and female servants. The aggregate annual value of a military medical appointment spread over twenty years, was £302, with the right to retire after the expiration of the same period on £219.33
Yearly Pay £302 0s 0d
Band and Mess 12 days' pay at 17s 6d £10 14s 6d
4 days' extra pay for band (voluntary) £3 10s 0d
Mess guests, annual ball and other incidental expenses £2 a mth a yr £24 0s 0d
Soldier servant and groom per yr £12 0s 0d
Clothes and other expenses connected with servants £10 0s 0d
Forage over allowance granted by Government £15 0s 0d
House maid and cook £30 0s 0d
Extra fuel and light £5 0s 0d
Odds and ends £10 0s 0d
Furnishing lodgings £96 0s 0d
Family expenses connected with annual moves £10 0s 0d
TOTAL £225 4s 6d

Half-pay was granted as a remuneration for military services. It carried an obligation on the part of the officer to return to his military duties whenever required. Any officer unable or unwilling to return to the service was forced to commute his half-pay for a single lump sum. At the end of the Napoleonic War a large number of officers found themselves relegated to half-pay on the reduction of their regiments. When a reduction took place, the Director General did not reduce to half-pay those who were juniors in each rank, but those who had served the least number of years from the date of their commission. The reverse took place when medical officers were required to fill vacancies, and they were recalled in the order of total length of service.

The Royal Warrant of 1867 gave medical officers the right to retire on half-pay after 20 years' service. Those at the rank of Surgeon Major or Surgeon were placed on the retired list at 55 years, and all Surgeons-General and Deputy Surgeons-General at the age of 65 years. A medical officer placed on half-pay by reduction of establishment, or in consequence of wounds or ill health caused in the discharge of his duties, or on account of age, was entitled to half-pay. The Estimates of 1889-90, showed 493 retired officers against 916 on the active list. The large number of retired officers was due to the compulsory age of retirement, and to the right of every medical officer to retire after twenty years' service. Many of them were worn out, and chose this option instead of being retired by a Medical Board, on the grounds of ill-health.

The Royal Warrant of 1873 allowed every medical officer who retired after a service upon full pay of twenty-five years, a rate of half-pay equal to seven-tenths of the daily pay he was in receipt of when he retired on half-pay, provided he had served three years in his rank, or had served abroad for ten years in all ranks, or for five years with an army in the field. An officer of twenty-five years' full-pay service, whose service fell within neither of these conditions, was entitled to only seven-tenths of the daily pay he was in receipt of prior to his last promotion. Those who retired for their own convenience, after twenty years' service on full pay, were granted a half-pay of not more than one-half of their full pay at the time of retirement. A medical officer placed on half-pay from any other cause was allowed only a temporary rate of half-pay for such period, and at such rate as decided by the Secretary of State for War with reference to the services rendered to the public by such officer. Medical officers of twenty years' full-pay service, placed temporarily on half-pay on account of ill health, were allowed to retire on permanent half-pay, if, after one year on half-pay, they were reported by a medical board to be permanently unfit for further service.

The Camperdown Committee of 1889 recommended "three years in a rank" before officers were permitted to retire. It allowed Surgeons-General to serve until 62 years of age and confirmed the compulsory retirement of Brigade-Surgeons at 55 years of age.

Table XI Royal Warrant of 1 March 1873
Established the following daily rates of Pay
Rank > 5 yrs > 10 yrs > 15 yrs > 20 yrs > 25 yrs > 30 yrs > 35 yrs
  FP HP FP HP FP HP FP HP FP HP FP HP FP HP
The RW of 1 March 1873 abolished the rank of Assistant Surgeon. Those holding such a rank were promoted to the substantive rank of Surgeon, with no increase in pay. Surgeons were promoted Surgeons Major without the pay of the new title. A supplement to the RW dated 23 Oct 1873 reinstated the pay of a Surgeon after fifteen years' service in that rank to 17s 6d a day.
Surgeon–General £2   £2   £2   £2   £2 5s £1 10s £2 7s £1 13s 6d £2 10s £1 17s 6d
Deputy Surgeon–General £1 10s   £1 10s   £1 10s   £1 10s   £1 12s £1 1s £1 15s £1 1s £1 17s £1 1s
Surgeon Major 17s 6d   17s 6d 11s £1 13s 6d £1 4s 16s 6d £1 7s £1        
Surgeon 10s 6s 12s 6d 8s 15s 10s   17s 6d            
Table XII The Royal Warrant promulgated on 2 December 1879
Established the following rates of pay
Rank Rates of pay
  > 5 yrs > 10 yrs > 15 yrs > 20 yrs > 25 yrs > 30 yrs
  FP HP FP HP FP HP FP HP FP HP FP HP
Daily rate of pay Royal Warrant 2 December 1879
Surgeon-General £2 15s £2                    
Deputy Surgeon-General £2 £1 15s                    
Brigade-Surgeon £1 10s 0d   £1 13s   £1 13s   £1 13s £1 7s 6d £1 13s £1 10s 0d    
Surgeon Major £1 0d     £1250
gratuity
£1 2s 6d £1800
gratuity
£1 5s £1 0d £1 7s 6d £1 2s 6d £1 7s 6d £1 5s 0d
Surgeon £200 / yr   £250 / yr £1250
gratuity
15s / day £1800
gratuity
           
Surgeon on probation 8s                      

The provisions for widows and orphans under the terms of the Royal Warrant of 1826 are shown in table XIII. General Orders and Circulars of the Army of 1830 stated that claims of widows of officers married before 1 January 1831 were dealt with under the Royal Warrant of 13 June 1826, whereas those who married after 31st December 1830, were to be granted under the Royal Warrant of William IV who succeeded his brother George IV on 7 July 1830.

Table XIII Pension for widows married before 1 Jan 1831 (USJ 1830 part 2 p 622-624)
Rank Widow's Pension (£) Special pension Officers (£)
Killed in Action (KIA)
Compassionate allowance legitimate children Aggregate amount of family allowance not to exceed
    To widow in lieu of ordinary pension To mother or sisters Officer KIA £/yr Officer not KIA £/yr Officer KIA £/yr Officer not KIA £/yr
Scale of pension under Royal Warrant George IV dated 13 June 1826.
IGH 80 200 80 16-20 12-14 350 Amount not exceeding the hp attached to the rank of the officer
DIGH 60 90 60 12-16 9-12 200  
AIH 50 70 50 12-16 9-12 150  
Reg/Staff Surg 45 55 45 12-16 9-12 125  
As Surg 40 50 40 8-14 5-10 100  
Purv 45 55 45 12-16 9-12 125  
Dep Purv 30 40 30 8-14 5-10 65  

Medical officers found it difficult to make provisions for their families, in the event of their death. Unlike the combatant officer, they were unable to obtain an income through the sale of their commission. They had to wait twenty five years before they could retire on half-pay. By then, they had given the best part of their professional lives to the service, and were worn out or infirm. They were past their best. Trying to compete and re-establish themselves in a strange civilian world, which they had left behind thirty years previously, was not easy. The destitute condition of the families of medical officers may be conceived, from the fact that during the year ending May 1837, seventy-two children were relieved by £345, subscribed by the department. Many of these children were the orphans of Regimental and Staff Surgeons.37

Epilogue

The Army Medical Department, which in the early half of the 19th century was disunited and beleaguered by its members, who felt their vested interests ignored, metamorphosed into a united Royal Corps towards the close of the century. The long gestation was helped along by deputations from the Parliamentary Bills Committee of the British Medical Association which maintained sustained pressure on the War Office to ameliorate the pay and terms of service of medical officers. The Medical Department's mandate of finding sufficient qualified staff for campaigns and expeditions was made harder by Medical Schools and Royal Colleges which dissuaded their students from a military career, until pay and conditions had improved. There was a constant struggle against an entrenched War Office and a tight fisted Treasury.

Medical officers throughout the century strove to be regarded as an integral part of the army, and not merely as camp followers. They demanded to be received by gentlemen as gentlemen, and not to be treated less respectfully than the officers of other scientific corps, such as the Engineers and the Artillery, and certainly not less respectfully than the Commissariat and the Army Service Corps. The medical officer who emerged from the Crimean War was unrecognizable from his counterpart of the Peninsular War. He was now doubly qualified in medicine and surgery, passed a competitive examination to enter the Army Medical School at Netley, completed a four month course at the Royal Victoria Hospital and had to be re-examined before obtaining his commission and promotion to a higher rank.

In December 1874 Francis De Chaumont Assistant Professor of Military Hygiene at the Army Medical Cool Netley published a pamphlet entitled the Pecuniary Value of the Emoluments and Pensions of Army Medical Officers in which he weighed up the advantages and disadvantages of a career in the Army Medical Department. De Chaumont asserted that the service offered the prospective candidate: "A certain, but small provision for life; Not very arduous work; Leave to be counted upon every year; Provision for sickness and a family; A small pension". He listed the main disadvantages, as a higher mortality among medical officers as compared with civilians of a similar age, and a chance of only 1 in 30 of achieving promotion to the administrative ranks. From a fiscal point of view, this was equal to about £6 or £7 per annum.

Each candidate to the Army Medical Department had to determine for himself whether the Army Medical Service was worth committing twenty years of one's life to, before leaving on a pension. Would one have been financially better off in a stable civilian job, where it would have been more feasible to establish a wide circle of friends and a permanent home, and in the interim avoiding the worry of constant moves? It was up to each young medical gentlemen to weigh the advantages and disadvantages and reach a decision about his professional career.

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