London, United Kingdom
In March 2007 Surgeon Captain Campbell lowered the flag and led his staff on a march out of the Royal Hospital Haslar, marking the closure of the United Kingdom’s last dedicated military hospital.1 The hospital had been at the core of the care system for the United Kingdom’s Royal Navy for more than two centuries. The Royal Navy has shaped the course of the history of Britain as an island nation, exerting more influence than any other navy in history, becoming part of the very fabric of British culture. The closure of the Royal Hospital Haslar marked an important stage in the history of both the Royal Navy and the British Isles.
Eighteenth – Century Origins
The eighteenth century was a tough time to be at sea, and even tougher for a naval mariner. Conditions aboard ships were appalling; malnutrition and disease were rife. Even in peacetime thousands of seamen required medical assistance each year, the threat from illness being much greater than that from the enemy. Records from 1759 show that the Seven Years War with France had so far inflicted just 143 combat casualties on the Royal Navy, yet 13,000 men had died from illness.2 A complex contract system of outsourcing the care of mariners to civilian hospitals and private lodging houses had been used by the Royal Navy, but it was far from ideal. Substandard conditions, ill-discipline, and desertion were all prevalent in these disparate sites.3 The contract system had its roots in the Chatham Chest Fund, a scheme dating from the late sixteenth century whereby every parish was required to put aside money for the welfare of its disabled seamen, supplemented by a mandatory deduction from all mariners’ wages.4 As a social welfare mechanism, it was undoubtedly forward thinking (it was established some 350 years before the creation of the National Health Service), but its good intentions were somewhat negated by less-than-honest fund administrators whose misappropriations were commented on by the eminent diarist, Samuel Pepys.4 As Clerk of the Acts to the Navy Board, Pepys was well placed to comment on the inefficiencies and corruption of the system.4
As the Royal Navy grew in size and evolved into an efficient fighting force, the need to improve the care of its men became crucial. In 1744 the Earl of Sandwich petitioned the Crown on behalf of the Navy Board to fund the construction of several dedicated naval hospitals.3 Several were required, and the priority was to build a facility close to Portsmouth, one of the Royal Navy’s most important home ports. In 1746 plans were rapidly drawn up and foundations laid on a site just across the water from Portsmouth.3 The agreed design, an enclosed quadrangle, was based on Palladian principles and borrowed extensively from Inigo Jones’ elegant Greenwich Palace.4 Patients were first received in 1754, prior to the completion of building works in 1762.4 Although the fourth side of the quadrangle was never built, the final building remains imposing to this day, and the façade of more than 560 feet gave the hospital the honour of being the largest brick building in the British Isles for a time.5
Whilst the construction of Haslar and its sister hospital in Plymouth (another major naval base) provided the Royal Navy with its own healthcare facilities, the contract system lingered on. Since the press gang system continued to be a major supplier of men for Royal Navy, the desertion of infirm seamen from shore establishments continued unabated, even from the stricter environs of naval hospitals. Haslar was modified: bars were added to the windows of the ground floor, and the fourth side of the quadrangle was completed with a high fence.4 It was not until the end of impressment (“press ganging”) in 1814 that the problem of ill sailors deserting shore establishments ceased to be so grave a concern.6
James Lind, chief physician
One of the most revered names in the history of Haslar is James Lind; his memorial at his alma mater, Edinburgh Medical School, praises him as “the Hippocrates of Naval Medicine.” He progressed from serving as ship’s surgeon aboard HMS Edinburgh to be Chief Physician at the Royal Haslar Hospital, a position he held for some twenty-five years from 1758-83.7 In the first two years under Lind’s control, the hospital had 5734 admissions, of which 1146 were due to scurvy.3 By conducting the world’s first ever clinical trial, Lind established that eating citrus fruit prevented sailors developing scurvy and, perhaps more importantly, laid the theoretical foundations for today’s evidence-based medicine.7 The Institute of Naval Medicine reflects his legacy by including a lime tree on its crest; British sailors’ consumption of this tree’s fruit is the origin of the somewhat derogatory North American term for the British, the “limey.” Lind’s efforts to improve the health of British mariners ushered in an era of unprecedented success for the Royal Navy, for a time dominating the world as only the legions of Rome had previously.
The hospital was built with some 1800 beds, comparing favourably with the UK’s largest hospitals of today.4 Over the years there have been transient increases in capacity according to demand, for instance when the hospital housed and treated over 2000 patients during the Crimean War.4
Haslar bolstered its reputation for being ahead of its time by demonstrating its proficiency at collaborative work from early on in its history, continuing this trend until its closure. Joint operations and interagency work is particularly relevant both for our generation’s military and healthcare systems, largely driven by the economic reality of Britain’s place in the world today, demanding constant improvements in efficiency across all domains of public expenditure.8 As long ago as the Peninsular War of the early nineteenth century, Haslar and the Royal Navy worked in partnership with the British Army to provide care for conflict casualties,5 pre-empting the collaboration that is today at the heart of the mission of the Royal Centre for Defence Medicine, coordinating care for the entire British military.9 This theme of collaboration and uniting to act in the best interests of the patient, regardless of their uniform, continues throughout the history of Haslar. Most notably, casualties from all branches of the British military were treated in vast numbers at the hospital during World War Two, including those from the D-Day landings (Operation Overlord).10 In 1966 the hospital was renamed the Royal Military Hospital Haslar, reflecting its new role as a shared centre for the British Army, Royal Air Force and Royal Navy.11
Haslar in the Second World War
Haslar has played an integral part in the care of British servicemen and women through countless conflicts and during peacetime. During the Second World War the hospital revealed its position as a great innovator, demonstrating the pattern of medicine taking great strides forward in times of war: indeed, Hippocrates himself is credited with proclaiming that “war is the only proper school for a surgeon.”12 This pattern was arguably established by Imhotep in Ancient Egypt, being reinforced throughout history by luminaries such as Ambrose Paré in the Middle Ages and Harold Gillies during World War One.12 The Royal Hospital Haslar’s most famous wartime contribution to medical history was to be the location of one of Britain’s first blood banks, established in the 1940s.13
The Royal Hospital Haslar ceased to treat military patients in 2007 and closed its doors to all patients in 2009. The UK military had identified the need to upgrade healthcare facilities to bring them into line with other twenty-first century hospitals, and the centre of UK military healthcare was relocated to the purpose-built Queen Elizabeth Hospital in Birmingham, a predominantly civilian (National Health Service) establishment with a high proportion of military staff under the auspices of Defence Medical Services. Whilst the benefits of providing care in a modern facility are countless, one cannot help mourning the end of more than 250 years of tradition. Redevelopment of the Haslar site is planned, with the main hospital building becoming home to a veterans’ community.14
- “Military Hospital Marks Closure”; BBC News Online. March 30, 2007; http://news.bbc.co.uk/1/hi/england/hampshire/6509337.stm, 30 March, 2007.Last Updated 30 March, 2007. Accessed October 12, 2014.
- Wilson BA. Empire of the Deep: The rise and fall of the British Navy. ISBN-13: 978-0297864080 Weidenfield & Nicholson, 2013.
- Keevil JJ, Coulter JLS, Lloyd C. Medicine and the Navy, 1220–1900 (vols 3, 4.). Edinburgh: E & S Livingstone, 1957.
- Tait WFS. A History of Haslar Hospital. Portsmouth: Griffin & Co., 1906.
- Birbeck E, Ward A, Ward P. The Royal Hospital Haslar: A pictorial history. History Press, 2013.
- Royal Navy Museum website; http://www.royalnavalmuseum.org/info_sheet_impressment.htm. Published 2001. Accessed October 13 2014.
- Milne I. Who was James Lind, and what exactly did he achieve? JLL Bulletin: Commentaries on the history of treatment evaluation James Lind Library website. (www.jameslindlibrary.org) 2012. Accessed October 17, 2014.
- Spending Round 2013 (Cm 8639). In: HM Treasury, ed. TSO; 2013: 5. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/209036/spending-round-2013-complete.pdf. 2013. Accessed November 30, 2014.
- Royal Centre for Defence Medicine. Website, http://www.uhb.nhs.uk/rcdm.htm. 2014. Accessed November 5, 2014.
- Royal Naval Hospital Haslar. D-Day Museum. Website, http://www.ddaymuseum.co.uk/d-dayonyourdoorstep/details/royal-naval-hospital-haslar. 2014. Accessed November 6, 2014.
- History. Haslar Heritage Group -, http://www.haslarheritagegroup.co.uk/index.php?option=com_content&view=article&id=73&Itemid=91. Published 2009. Accessed November 5, 2014.
- Brought to Life – Medicine and War. Science Museum. Website. http://www.sciencemuseum.org.uk/broughttolife/themes/war.aspx. Accessed November 6, 2014.
- Nicholson V. Millions like Us: Women’s lives in war and peace 1939–1949. London: Viking. 2011.
- Royal Haslar. Website. http://royalhaslar.com/?page_id=339.. Accessed October 13, 2014.
BEN L.WILLIAMSON, DHMSA BSc (Hons) is a final year medical student and Royal Navy medical cadet based at King’s College London. He enjoys a range of interests both within medicine and without. He is currently studying towards a Diploma in Conflict and Catastrophe Medicine at the Worshipful Society of Apothecaries, where in 2013 he was awarded a Diploma in the History of Medicine. He hopes to pursue a surgical career, following a period as a frontline military generalist.