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A tribute to the Journal of the Royal Army Medical Corps
  1. Alistair Macmillan DL
  1. RAMC Association, Johnstone, UK
  1. Correspondence to Dr Alistair Macmillan, RAMC Association, Johnstone, UK; ironfist{at}glenacardoch.com

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Issue 1, Volume 1 of the Journal of the Royal Army Medical Corps appeared at the end of July 1903 and was the realisation of a hope for many years (Figure 1). The need for such a journal had long been recognised by medical officers in the Army. Indeed, as long ago as 1864, the year after the Army Medical School had reformed at the newly opened Queen Victoria Hospital, Netley, a meeting was held to scope such a requirement. However, military bureaucracy rendered the idea stillborn. But, as ever, War, and its reflective aftermath, was the stimulant to the idea going to full term and being delivered. The Boer War had a profound effect on improving the Army Medical Services, and one such reform was the plan to move the School up to London, along with its significant Library, eventually passing into a brand new Royal Army Medical College. This would not open until 1907, but the Director General of the day, Surgeon-General Sir William Taylor, was determined that the Journal would go ahead as soon as possible.1

Figure 1

The front cover of the first issue of the Journal in 1903.

The Library and the Journal were to be put under the management of a Library and Journal Committee that consisted of members drawn from the Army Medical Directorate, the College and the Medical Advisory Board (also set up in the wake of post-Boer War reforms). The Secretary of State for War authorised additional monies for the appointment of a librarian, and a relatively young medical officer, Major Firth, was appointed as the first editor of the Journal. It was then agreed that the Journal would embrace the following:

  • Original communications written by officers of the Royal Army Medical Corps (RAMC) and others (Figure 2).

Figure 2

An example of an early original communication in the Journal.

  • Bibliographical notes on articles of importance and interest to the military services.

  • Reprints and translations from military, medical and other journals.

  • Official gazettes and official information generally bearing on the Army Medical Services.

The relationship with the Library, through its core content of over 2000 volumes, was seen as pivotal in providing facilities for giving bibliographical assistance to officers in investigation or research. Consequently, it was also seen as being a vehicle for medical officers, all around the Empire, keeping in touch with not only advances and what was going on in the British Service, but in other armies as well. There was a call for medical officers with special knowledge, foreign language or reviewing skills to make themselves known to the Committee.

The first article in the first issue of the Journal was a report on hospital arrangements on board sea transports.2 This was a meaty paper with much detailed organisational and administrative description. It would not take long for the Editor to realise that such a paper would be better served being split into sections that could be published in a series of issues as it was not a scientific paper that needed the integrity of being a single entity to grasp the essence of the data, its explanation and interpretation.

This was followed by the first case study,3 then an article on clinical manifestations of a disease4 and then a report on a medical relief expedition in the West Indies.5

The second issue featured the first of a series on clinical experiences from the Boer War6 and the introduction of Corps News that embraced appointments, honours, awards, academic achievements, posting locations, officers’ funds management and unit news from about and around the stations (Figure 3). This latter news would feature strongly until diverted away during the Great War to make space for the vast volume of material emanating from the conflict, and then later much would transfer to the Gazette as a separate ‘parish news’ vehicle in 1925 established after the RAMC Association was formed (and now in the modern guise of the Medic Magazine). Corps News embraced the Volunteer Army as much as the regular one, and the quaint Victorian era ranks such as Surgeon Lieutenant Colonel could still appear in notices until the last cohort had wasted out. Corps News in those days also embraced the Queen Alexandra’s Imperial Military Nursing Service.

Figure 3

Corps News was a staple of the early issues of the Journal.

It only took to the second issue for the first of a series of historical essays on the development of the Army Medical Services, from the Civil War to the formation of the RAMC in 1898, to be published,7 and these went on periodically until 1940 by first Captain Howell and then Lieutenant Colonel Kempthorne.8 While not doubting the veracity of the historical detail in the myriad articles produced by both these officers, and despite their access to the contents of the Library, they did not include reference to any primary (or for that matter, secondary) sources to back up their work. Interspersed with them were vignettes on other historical occasions and phenomena under the series ‘Echoes of the Past’. From the beginning there were book reviews in each edition normally divided into medicine and surgery, and pathology and hygiene sections. One is reminded that the RAMC used to manufacture its own vaccines in Edwardian times9 and that this facility endured through two World Wars and onto the end of the Cold War at the David Bruce Laboratory at Everleigh. Very early on, and akin to many a medical journal, births, marriages and deaths notices were prominent. Sometimes obituaries would be quite voluminous when covering the lives of the great and the good such as Lieutenant General Sir Alfred Keogh, Director General Army Medical Services, 1904–1910 and 1914–1918.10

An important thread that ran through the Journal from the beginning was field medical organisation and tactics. There was no other ready vehicle for this subject matter and, of course, the College was also seen as the Medical Services’ Staff College and not just a school for military medicine, surgery, pathology and hygiene. Rightly the first article on this topic started at the front line.11 There was also room for details of the volunteers at their camps.12 Another feature was reports of overseas garrisons that described the local climate, fauna, flora, disease threats and the indigenous population. These were very useful for reference and were the precursors to health briefs and travel health guides of later years.13 Disease had been the great and grim reaper for soldiers for millennia, and for UK troops had always resulted in more deaths in a campaign than ever the armed efforts of the enemy could achieve. This was to change on the Western Front in the Great War (but not necessarily in other theatres such as Egypt, Salonika and Mesopotamia). The development of medical science had shown the way and the Boer War had demonstrated the Army’s, and the RAMC’s, weaknesses in hygiene and sanitation. Unsurprisingly, the Journal led early on in such matters. Major Horrocks14 described the dangers of sewage contamination in the first of countless articles by many authors on prevention and public health matters published over the years. Horrocks went on to become the third editor of the Journal (for an unrivalled period of 33 years), and did sterling work in the Great War devising water sterilisation and testing equipment as well as the first gas masks in 1915. He became the first Director of Hygiene in the Army Medical Directorate when the post was established in 1919, and he fathered Lieutenant General Sir Brian Horrocks, the very successful Corps Commander in the eighth and then second armies in World War II.

The first volume featured the start of a series of articles covering the Report of the Royal Commission on the War in South Africa.15 While an important report that had led to great improvements in the Army Medical Services, it presaged a significant phalanx of others subsequently through the years that often produced more heat than light and increasingly have explored Tri-Service relationships, recruiting and manning, bricks and mortar, and not necessarily the effectiveness and efficiency of the Army Medical Services. Indeed, one might opine that the studies were conducted for other political reasons even when the Medical Services were at the height of their effectiveness and efficiency, a point that resonates to this day! The volume finished with an analysis of the German Army and its approach to voluntary aid on the battlefield. It was written by Lieutenant Colonel Macpherson,16 who would later report as an observer at the Russo-Japanese War of 1906 and further on was the Editor of the Official Medical History of the Great War.

Before concluding this wide examination of the Journal’s outset, it is appropriate to mention two medical giants who were members of the RAMC and who contributed to it early on, particularly with scientific papers. First, Sir William Leishman, who became Director General in 1923, the discoverer of leishmaniasis and the inventor of the Leishman stain, was Almroth Wright’s colleague and Assistant Professor of Army Pathology at the School before the Boer War, and assisted in the development of the first antityphoid vaccine. This was used sparingly and experimentally during the Boer War and had not gained a sufficient reputation for effectiveness as a consequence. It was Leishman, after becoming the professor himself post-Boer War, who completed the proof of effectiveness of the vaccine and published accordingly.17 Its use was widespread during the Great War and proved, in vivo, to be as effective as trialled. The other was Sir David Bruce, the identifier of the cause of sleeping sickness, who also published about the cause of a disease that was to become eponymous later but known then as Malta fever.18 Bruce was to become the second editor of the Journal and later Commandant of the College during the Great War.

At the beginning, a volume encompassed six-monthly issues of the Journal, that is, two a year. At that point a comprehensive index was constructed that allowed for an alphabetic search for each article that listed by title, keyword, theme and authors’ surname. Bound volumes with their indices are still found at the Museum of Military Medicine, the Regimental Headquarters of the RAMC and sundry other medical libraries around the country. They are now available in digital form over the internet courtesy of the BMJ Group. It did not take long before a vigorous input of correspondence ensued within each issue in response to published articles and papers as the great diaspora of medical officers responded to the undoubted added value the Journal gave their lives in remote parts. The model of two volumes a year sustained itself through two World Wars and up to 1951, thereafter a volume has been produced annually.

There isn’t scope to cover, in an article like this, the detail of the ensuing biannual volumes except to pay tribute to the sheer quantity of input from the RAMC, sometimes the Indian Medical Service in its day, and occasionally from the Royal Navy (RN) and, after 1918, Royal Air Force (RAF) Medical Services. There were two clear peaks of relevant articles that encompassed the two World Wars. The underlying range and style of the articles were true to the original Journal purpose but totally focused on current matters. What is quite striking is the number of reports from young medical officers actively engaged on their battlefield duties and hot to report on their experiences. It should be remembered that most of these medical officers were volunteers from civilian life, on a temporary commission, with minimal military and military-medical training, and had a keen and pressing need for information. This was tempered by contributions from some of the medically eminent, also temporary, senior officers from civilian life, and often volunteers or territorials with Boer War experience, who contributed greatly to clinical standards in the field and spread clinical lessons and doctrine around the hospitals, casualty clearing stations and field ambulances of the deployed Army. People such as Sir Arthur Bowlby, Sir George Makin and Sir Thomas Hetherington became temporary Major Generals on the Western Front. There were also names of young medical officers who later became more famous in their later careers as civilian clinical leaders or authors such as Sir Gordon Gordon-Taylor and Hans Zinsser. The advances in early surgery, debridement of wounds, use of antitoxins, splintage of fractured femurs, gas injury treatment and prevention, combat stress management (shell shock), transfusion, intravenous fluids, brain and maxillofacial surgery, as well as novel medical conditions like trench fever, trench nephritis and trench foot were fully reported and discussed.

The Second War followed the same flow and described such matters as blood supply improvements, plasma, forward surgery, Tobruk splints, DDT, antimalarials, medical support to parachute and commando units, as well as the advent of penicillin. There was much more on medical reviews of campaigns and lessons learnt in organisational and doctrinal matters. By contrast, the block between the Wars had struggled to keep knowledge of organisation and hygiene alive but tended to reflect back to Great War experience. In 1948, all parish news and regimental matters were firmly placed with the Gazette’s successor, the Army Medical Services Magazine, leading to this subsequent Editorial statement19:

It is felt that the Journal should concentrate on our professional activities. The Magazine - which is supplied to all subscribers - covers social and general activities. From time to time there may be activities which, although not strictly professional, are more suitably recorded in the Journal. Our pages are always open to articles of a general nature dealing with travel, sport, unusual adventures or misadventures befalling officers of the Corps and the like. We are even prepared to accept metaphysical speculations and philosophical animadversions upon the vicissitudes of life in the Corps should any of our more seriously minded officers see fit to have their views recorded for the benefit alike of their fellows and posterity.

By 1952, with a contraction of the Army post-War, despite National Service persisting until 1960, the issues dropped to four a year (by 1979, this would drop further to three a year). The range and diversity of articles remained but the cohort of budding authors seemed not to be quite as voluble or as numerous as previous generations (Figure 4). It is of note that clinical and organisational aspects of the campaigns of the 1950s and early 1960s were relatively poorly covered by the Journal. It is to the credit of subsequent editors that from the Falklands War onwards the reporting and analysis of campaign medical matters were comprehensively documented and collated. A new feature of the articles published included the transcripts of addresses given by eminent clinicians at the noted annual lectures given at the College, such as the Mitchener Lecture.20

Figure 4

The Journal cover in 1981 had not changed for decades.

Perversely it has been the end of the Cold War that has given a new lease of life to the Journal and this has been through the sheer volume of military activity that has ensued. The first Gulf War experience, closely followed on by peacekeeping in the Balkans, has moved on into the 21st century and to Iraq and Afghanistan. The surge in deployments and medical activity meant that the production of articles expanded significantly to meet the demand for current knowledge and reporting of clinical and scientific advances. In 2002 the Journal returned to four issues a year, in 2015 this became five issues a year, and the following year became six issues a year. Supporting this have been theme-driven supplements on major current clinical issues and meaty reviews and reflections on the recent past (Figure 5). The background to this upsurge, beyond the simple maths of activity, has been the energy and enterprise of editors such as Ian Greaves and Jeff Garner. In Jeff’s time the stark reality of the technology needs, staff costs, time and production expertise were threatening to topple the ancient edifice the Journal balanced on. The RAMC Charity, the owners of the Journal, sensibly came to the conclusion that an experienced partner was required to shoulder this administrative burden, and a deal was struck with the BMJ Group to take over this task. The first edition of the new arrangement was published in early 2013,21 and a new style of the Journal appeared along with front cover (Figure 6). Editorship stayed with the RAMC, and in Table 1 is a list of all those who filled the role of editor since 1903. We now have an equally young and energetic editor in Johno Breeze, who thus neatly tails the heads of Ian Firth in 1903.

Figure 5

The Journal cover in 2009 shortly before joining the BMJ.

Figure 6

The BMJ Journal cover in 2019 shortly before the last issue.

Table 1

Editors of the Journal of the Royal Army Medical Corps

This sealed a very long-term relationship the RAMC, and its antecedents, has had with the British Medical Association (BMA), reaching back to Crimean War times, and the BMA was a heavy influence on attitudes to medical recruiting, military medical capability and then the formation of the RAMC in 1898. The BMJ Group has been able to use its marketing capability to enable much of the growth of material for publication and the circulation of the Journal. The increasing focus on original papers and the desire for international authors and readership have really lifted the Journal to a new level without losing long-established niches such as historical pieces. But the show has had to move on again. There have been attempts by the Ministry of Defence to curtail the editorial freedom of, and exert control over, the Journal. The growth in its international significance has made the Trustees of the RAMC Charity conclude that the Journal is now something that exceeds its core mandate, the well-being of the Corps members, its veterans and dependants, to manage and control. So it has decided to dispense with this responsibility and pass it on completely to the BMJ Group. This will allow the Journal, not necessarily under the traditional title, to expand and continue to rejuvenate itself more widely in the modern world yet stay true to the spread of knowledge of military medicine.

To conclude, it is fair to surmise that the good name and reputation of the Journal will go on. It sits well alongside other journals of note such as The Lancet, BMJ and Journal of the Royal Society of Medicine (with its United Services Section) that have published so much of military medicine and the lot of the medical man in the Army over 180 odd years. The collection of issues and volumes from inception in 1903 provides a rich and unique cornucopia of medical and military information that illustrates the overlap as well as the gaps between those two,22 to delight historians well into the future. May it also continue, occasionally, to accept metaphysical speculations and philosophical animadversions on the vicissitudes of life in the Corps. Much of these otherwise will naturally migrate to the Medic Magazine, but my one fear is where might we debate and describe medical doctrine and organisation within a medical scientific forum in the future? The Journal is dead, long live the Journal.

References

Footnotes

  • Contributors AM is the sole contributor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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