Reviewed by: Robert Muddysley

When, many years ago, your reviewer attended the Divisional School in some huts behind the wardroom in Victory Barracks, at the front of his classroom was a picture of a smiling matelot in square rig captioned ‘The Greatest Single Factor’. A similar picture adorns the front cover of this book, which sets out to examine how he (and she) were the ‘fittest and healthiest’ of the inductees into the British armed forces in the Second World War. Apart from a crisis period in 1943, the navy was able to take the best that came, or were brought, forward. This book describes how they were selected and by whom. It covers an immense amount; not only the medical aspects of the twentieth century press gang, but also the medical and dental officers who assessed them, and in turn their service training and that of the Sick Berth Attendants (now Medical Assistants), the nursing sisters (at that time there were no QARNNS nurse ratings), and the VAD nurses. It looks at how medical care was delivered and in particular what was for its day the humane treatment of battle stress and psychological injury; not for the navy the RAF grading of ‘Lack of Moral Fibre’ with reduction in rank and menial duties, indeed there was a naval psychiatric hospital at Barrow Gurney.

A significant portion of the book is devoted to public and occupational health issues. Ships, and especially submarines, were and still to an extent are not a healthy environment. Tuberculosis (TB) in particular was a scourge, before effective treatment many were invalided from the service with TB. This led to the introduction of annual mass miniature radiography to screen for the disease, ‘the most significant wartime development in preventative medicine’ (p.95).

Having only recently regained control of naval aviation from the RAF, inevitably the RAF led on most aspects of aviation medicine. The contribution of the Naval Medical Service was far from negligible and interestingly, aircrew preferred to be seen by naval medical staff, resisting referral to the RAF for specialist advice, in part because of the practice of a medical officer being appointed to a squadron where he became part of the unit.

There is an extremely interesting section on penicillin which had been discovered in 1928 but remained a medical curiosity for many years. Early in the war it proved possible to manufacture it in usable quantities. The Naval Medical School which had already been making vaccines, now undertook production of penicillin. Fortunately, there was a ready source of suitable glass bottles for the purpose, empty gin bottles! This was for a critical period one of the most important sources of a drug in short supply (the author does not suggest that there was a shortage of empty gin bottles). The shortage led to an ethical dilemma which eventually reached the prime minister. Which patients should get priority for penicillin? During the campaign in Italy, there were many more combat ineffectives due to venereal disease (VD) than from battle injuries. Penicillin had been shown to cure syphilis and gonorrhoea with a single dose, rather than the weeks that the then conventional treatments took. Wounded patients would take weeks or months, if ever, to be returned to the front line. Should VD patients be given priority for the limited supplies of penicillin? Churchill’s input was Delphic, but the decision was taken that VD was given priority.

Inevitably there is a lot in the book about venereal disease and some amusing anecdotes; after the liberation of Tunisia by the allies in 1943, it fell to a naval medical officer, Frank Henley, to medically examine the 20 prostitutes in one brothel (p.185). He reported to the captain superintendent that only three of them were free of disease. His ‘report was forwarded to Admiral Dickens, who signalled Henley asking for the names of those three girls.’

Morale is commonly lumped together with healthcare. While good healthcare is essential to good morale, its establishment and maintenance is far wider. This is the weakest aspect of this book, while morale is not defined in what is a narrative book, how the navy achieved high morale for the entirety of the war is only briefly dealt with. Nonetheless there are some interesting sidelights. It was generally accepted physical exercise was good for morale, but ‘there remained some suspicion that sport … should not be too enjoyable’, indeed some opposed giving naval air stations sailing boats to instil some ‘sea sense’ because the men might ‘obtain some pleasure as well as experience’!

It is interesting how relatively little of the book is taken up with treating casualties, even in the difficult circumstances at sea, because it was a relatively small part of the work of the medical service. Indeed, a large part of the section regarding casualty treatment deals with support of land operations, particularly around the Normandy landings when Haslar hospital’s contribution proved to be vital.

The author is an obvious admirer of the medical branch and its contribution to the fighting efficiency of the service. He has written before on naval medicine and as curator of the Alexander Fleming Museum at St Mary’s Hospital, does so with authority and has produced a very readable and interesting book. It is strongly recommended to members of the Naval Review with any interest in personnel matters, not just naval medicine.