This study rescues English and British military hospitals from the condescension of earlier historians. Picking up from the author's earlier survey of English medical care in the 1640s and 1650s (Justice to the Maimed Soldier: Nursing, Medical Care, and Welfare for Sick and Wounded Soldiers and Their Families during the English Civil Wars and Interregnum, 1642–1660 [Aldershot: Ashgate, 2001]), Gruber von Arni argues that the rump of a standing army remaining after the Restoration was too small to warrant a permanent military hospital, and it relied instead on the long-standing practice of using the London poor hospitals (St. Bartholomew's and St. Thomas’s). The garrison in the English colony of Tangier was a necessary exception to this rule until the colony was abandoned in 1683. A small military hospital was created at Tangier, but mismanagement and peculation meant that Tangier represented the “nadir” of army medical care (28). In England, a variety of ad hoc measures were deployed for each military campaign in the 1660s and 1670s (e.g., the reopening of the Savoy Hospital in London for the duration of the second and third Anglo-Dutch wars), but growth of the army meant that ad hoc arrangements gave way to experimentation, particularly influenced by French and then Dutch developments. The Royal Hospitals at Kilmainham in Dublin and Chelsea, established in 1679 and 1680 for veterans, were modeled on Louis XIV's Les Invalides in Paris. Further experimentation came with the establishment of a semipermanent hospital at Hounslow in 1686 for the annual training camps held on the heath there; one of the strengths of this book is the attention paid to little-known and temporary hospitals. After Kilmainham and Chelsea, the most significant development was the creation of a twin-tier system of privately contracted hospitals: fixed hospitals well behind the lines and mobile field hospitals to accompany the marching armies. Copying Dutch practice, the system was first used by William III's forces in Ireland during the War of the Two Kings, 1689–92, and was later extensively used during Marlborough's campaigns. Gruber von Arni unfolds a narrative of gradual change heavily dependent on the drive of a few competent individuals with a personal interest in improving hospital care. During the War of Spanish Succession he poses a marked contrast between the efficiency of British military hospitals in Flanders and Germany and the lax medical administration in Iberia: in the former, he sees a “competent commander” and a “brilliant quartermaster general” exerting “continuing personal interest” in the welfare of their troops, compared to “self-interested and incompetent leaders,” in the latter, who gave little thought to medical care (178).

The broad outlines of the argument will contain no surprises for any who have followed debates on the military revolution in the last half century, although, curiously, that debate is nowhere mentioned in this work. The book appears in the series The History of Medicine in Context, but the reader may be left wondering where the context has gone. Apart from the recapitulation of the details of the Tangier colony and various military campaigns, often from rather old secondary sources and usually at unnecessary length, there is little context here. Despite its title, the book is a narrow institutional history of military hospitals providing acute medical care. Kilmainham and Chelsea, despite the prominence accorded them in the argument about developments in provision, are barely investigated. There is almost nothing here on the care actually provided by the hospitals. Most of the patients appear to have been victims of disease rather than battle casualties, but we are told very little about the nature of the treatment provided, and there is no comparison with the treatment in either the naval hospital at Greenwich or civilian hospitals for the poor nor with the experience of ex-servicemen relieved by other means, such as county pensions or cathedral alms rooms. Gruber von Arni does, importantly, seek to shift focus from surgeons and physicians to nurses and the menial staff of the hospitals, but the nature of the sources means that most of the nurses remain anonymous (although he does suggest that many of them may have been soldiers’ wives); moreover, Gruber von Arni has perhaps gone too far in redressing the balance, and he tells us very little about the doctors either.

The overall assessment of the provision of medical care for soldiers is optimistic, probably unduly so, given the evidence mentioned in passing of high soldier mortality in hospitals in Belfast in 1689. Gruber von Arni does show that some soldiers survived, sometimes for several decades after quite horrific wounds, such as the soldier of Hawley's regiment who continued soldiering after having his left arm amputated at the battle of Almanza in 1707 and was wounded in the head at Brihuega in 1710; he lived and applied to be admitted to the Royal Hospital at Chelsea in 1723, but whether his recovery (and that of many others) was thanks to the institutional developments charted here is unclear. This is a narrative account (it is telling that the final chapter is called “Evaluation” and is a mere eight pages long) in which much evidence is presented but rarely analyzed. Gruber von Arni has opened up a fascinating subject and shows that the brief dismissal of army medical care in the later Stuart period by earlier historians is unjustified, but the history of the experiences of sick and injured soldiers and their carers in the period remains to be written.