The Royal Naval Medical Service from the earliest times to 1918
Jane WickendenMA(Oxon) DipLib
Historic Collections Librarian, Institute of Naval Medicine, Alverstoke, Gosport
Rules relating to the provision of medicine at sea have existed for centuries: the earliest known in English derive from the 12th-century Rules of Oléron, codified in 1336 as the Black Book of the Admiralty. The surgeon’s kit from the Mary Rose (sunk off Portsmouth in 1545) can still be inspected, and there were surgeons aboard the ships that fought the Great Armada of 1588.
From 1626 the Company of Barber-Surgeons undertook the training and examination of ship’s surgeons for the Navy, and the supply of their medicines and instruments. In 1652, at the beginning of the Dutch Wars, the Admiralty founded the precursor to the Sick and Hurt Board, and developed arrangements for the care of sick and injured seamen in seaport hospitals. Surgical and medical techniques steadily improved, and although the lot of the Naval surgeon was variable – often they had to pay for their own instruments and supplies for example – they were not without status: surgeon James Pearse was a friend of Samuel Pepys.
For most people the history of Naval medicine begins with James Lind, the ‘Father of Naval Medicine’, who carried out one of the earliest recorded clinical trials aboard HM Ship Salisbury (50) in May 1747, seeking a cure for scurvy. For years diseases such as malaria, typhoid and yellow fever, and dietary deficiencies causing dysentery and scurvy, killed far more men than injury in battle, making the fight against disease as important as more conventional warfare. Lind’s Treatise on the Scurvy was published in 1753, the year of the opening of the Royal Hospital Haslar. The Naval hospitals at Jamaica and Port Mahon (Minorca) were older, but Haslar was the first to be built in Britain. It was followed within the decade by Stonehouse at Plymouth, and later by Great Yarmouth and Chatham. Elsewhere, in the 1780s Naval surgeon James Ramsay was a key mover of the campaign to abolish the slave trade.
1805 saw the victory at Trafalgar, in which the good health of the Royal Navy’s sailors played a major part. In 1807 the slave trade was abolished in Britain, and the Royal Navy was committed to stopping the trade, particularly in the Atlantic but also in the Indian Ocean. There were appalling losses amongst the seamen on the West and East African anti-slave trade stations to disease, and in the 1840s Alexander Bryson, a naval physician later to be Medical Director-General of the Navy, laid the foundation for the sciences of medical statistics and epidemiology while researching preventive measures against yellow fever and malaria. Mosquitoes were not identified as the vector for these diseases until the 1890s, knowledge which came too late for surgeons such as Sidney Bernard of the wood-hulled paddle-sloop HMS Eclair, who died in service in 1844.
The status of the Royal Naval Medical Service continued to rise, though erratically, at one period in the early Nineteenth century coming under the control of the Transport Board. It was 1866 before pay and conditions for Naval surgeons approached, and 1881 before they matched, those of Army surgeons. In the 1830s the Medical Officer’s Journal system was instituted, and with it the Gilbert Blane award. Medics and surgeons were allocated Naval ranks in 1857, with accompanying uniform, and from 1863 surgeons wore the characteristic red distinction cloth between their gold rings. The Dental Service was founded in 1880.
RNMS officers and men served worldwide in H.M. ships, Naval hospitals and convict ships; ashore in the Naval brigades of the Crimean War (1853-56) which also saw the founding of the Naval Nursing Service under the leadership of Mrs Eliza Mackenzie, and the First South African War (1880-81); investigating diseases, cures and surgical techniques, and publishing their findings; working as botanists and zoologists such as T.H. Huxley; exploring, like George Bass of the Bass Strait, and one – Will Maillard in 1898 – winning the Victoria Cross. Captain Scott’s Terra Nova expedition (1910-12) included two Naval medical men, Surgeon Commanders Edward Leicester Atkinson and George Murray Levick.
During the Great War (1914-18) RNMS personnel saw service ashore – Atkinson and Levick, back from the Antarctic, both served with the Royal Naval Division at Gallipoli and on the Western Front – or afloat in sea battles such as Jutland (1916). The development of the Submarine Service and the Royal Naval Air Service provided new medical challenges. In 1915 the Journal of the Royal Naval Medical Service published its first issue.
Many RNMS officers and men died in the war and in the influenza pandemic that followed, while for the first time women were officially involved with, and sharing the dangers of Naval medical care at sea. Queen Alexandra’s Royal Naval Nursing Service (QARNNS) received its charter in 1902, and nurses were among the casualties in 1918 when HM Hospital Ships Rewa and Glenart Castle were torpedoed and sunk.
It has always been the case that war stimulates medical and surgical advances, and the history of the Royal Naval Medical Service bears witness to this: it emerged from the trials of the Great War ready for the challenges of the later twentieth century and onwards, remaining the proud and effective service that it is today.