Writing the field hospital manual

I took command of 22 Field Hospital, one of the three permanent field hospitals in the Army, in October 1999. As this was my first time I had worked with a field hospital, I looked around for the instruction book. It was nowhere to be found. The only time I had seen a field hospital was in 1996 in Bosnia. This experience seemed a good place to start but I had difficulty finding much practical information about what had actually happened. I visited the Army Medical Services Museum in Ash Vale to read through some back copies of the ‘Journal of the Royal Army Medical Corps’. Here I found a rich tapestry of practical advice on running field hospitals in scientific papers from the First and Second World Wars. Looking further back, it was the lessons from the Boer War that truly created the field hospital (called the Clearing Hospital). Even more information was contained within the Official Histories of the Army Medical Services for these wars. If only I could find the time to study this subject properly.

In September 2000, I noticed an advert in the BMJ for the Short-term Research Fellowship scheme sponsored by the Wellcome Trust. This seemed to provide me with the opportunity I needed, if I could arrange the time off from the Army and present a project proposal. To summarise a long period of negotiation, I was awarded a research expenses grant because there is no mechanism to provide locum cover. I developed my own, short-term, answer to how to run a field hospital and took my unit to Oman in 2001 as part of the largest deployment of UK military forces since the Gulf War. I handed over the job in January 2002 and started a three-month spell at the Wellcome Trust Centre for the History of Medicine at University College London. My plan had come together.

I spent the first part of my time collecting information. The Wellcome Library for the History and Understanding of Medicine and the Army Medical Services Museum were the main repositories, but I found some useful information in the library of the Royal Defence Medical College, Prince Consort’s Library in Aldershot (part of the Army library service) and the Army Tactical Doctrine Retrieval Cell.

The next challenge was reading and collating the material. I found that the whole military medical system was driven by the clinical need to provide operative surgery for the war wounded. This defined the organisation and design of field hospitals, and so my project evolved into a review of the evolution of military casualty evacuation from the Boer War to the present day.

The highlight of my project was a trip to the USA. This started with one week in Washington DC to visit the historical sections of the Office of the Surgeon General, the Uniformed Services University of the Health Sciences and the Borden Institute. My second week was spent at the US Army Medical Department Center and School visiting the museum, historical section and the lessons learned section. This provided me with some valuable material upon which to compare the UK and US military medical systems.

As always, the write-up was the hardest part of my project. The Wellcome Centre provided me with an excellent place to settle in peace and focus on meeting my deadlines. The final versions of my papers are with the Editor of the ‘Journal of the Royal Army Medical’ for review. My short association with the Wellcome Trust as a research fellow has reinforced my passion of medical history as a mechanism for ensuring the experience of the past is used to learn lessons for the future. I now have the challenge of putting this into practice in my next appointment as Chief Instructor at the Defence Medical Services Training Centre.

Martin Bricknell is a Lieutenant Colonel in the Royal Army Medical Corps.

See also

• The unkind cut: Article on a History of Medicine Research Fellowship project on the forgotten European story of lobotomy’s first years