In 1746 Dr John Buchanan, recently retired as a medical officer in the British Army, produced a manuscript entitled, ‘Regimental Practice, or a Short History of Diseases common to His Majesties own Royal Regiment of Horse Guards when abroad (Commonly called the Blews)’. Revised in several stages almost until the time of Buchanan’s death in 1767, this work was for the most part based on the author’s observations while surgeon to a cavalry regiment serving in Flanders 1742–5, during the War of the Austrian Succession. It was never published, but now, thanks to the labours of Paul Kopperman, we have two annotated modern editions of a text that reveal much about the everyday practice of medicine in the eighteenth century. The first edition is the one under review as published by Ashgate Press while the second edition is a much longer electronic version of the book with appendices available only from the author himself. Such practices may become common, as Kopperman notes, in providing a book for a press’s audience and another for readers who require extensively annotated primary sources. Cost is of course the major factor here.

Kopperman’s introduction is divided into three sections which provide a biography of Buchanan, a discussion of his medical education and, finally, an analysis of the medical practice found in the manuscript. As he notes, Buchanan’s work is rare in focusing on a single regiment and the author cites only one other example as being published in the eighteenth century. Kopperman states that there are crucial differences between that work (by Thomas Dickson Reide in 1793) and Buchanan’s: Reide’s is coloured by a forceful argument for a particular type of therapeutic approach while Buchanan’s practice of medicine generally represented the mainstream of professional practice in his theories and practices of diseases. This is the overriding thesis of Kopperman’s annotations, to demonstrate that methods used to treat diseases, wounds and injuries were essentially agreed upon in the eighteenth century. In doing this he is questioning the idea of there being much debate over practice among Georgian physicians and surgeons as outlined by previous medical historians.

Buchanan was born in 1710. Details of his life are sketchy but he was probably apprenticed first to a surgeon in Edinburgh before becoming a regimental surgeon. At some point he obtained an MD from an unknown location. Early on Buchanan appears to have recorded his medical notes with the intention of publishing them, concealing some patients’ names, and making revisions including grammatical ones. Kopperman notes that this plan was abandoned later on but we do not know why. As a regimental surgeon, Buchanan was responsible for 250–300 men and officers, their wives and children, servants, labourers, farriers and also the horses.

Far from being isolated from other medical men, Buchanan was part of a community of regimental surgeons. He refers to the mention of a weekly club, where any unusual cases were presented and the health of the army in general was discussed. Buchanan’s named sources, however, were classical, especially Hippocrates, Ovid and Horace. He had a decent knowledge of Latin and perhaps some French. Interestingly, the manuscript only refers to one modern source, that of John Ranby’s Treatise of Gunshot Wounds. Having said this, Kopperman reveals that Buchanan appears not to have patterned his practice on any one authority – even Hippocrates, who was a point of reference rather than a guide to treatment. Observation appears to have trumped classical authority. Buchanan carried out some autopsies and watched surgical procedures. He made remarks on the causes and effects of epidemics based on the study of differing groups (officers, men, servants) who came down with the disease. Gout affected the officers in greater number than the men while ‘the Itch’ affected the men but not the officers. Kopperman describes Buchanan as a modern rather than an ancient when it came to determining the causes of a disease. He was critical of French practice and, while they were the enemy, this also fit with other surgeons’ views of French medical treatment. One theme that stands out strongly in the manuscript is that time in hospital as a patient was to be avoided at all costs. Hospitals were not only sources of disease but encouraged laziness and indolence in some soldiers and melancholy in others who were left behind when the regiment moved. There is quite a lot of attention paid to the character of troopers which Kopperman rightly draws attention to. Buchanan noted that men complained if he offered common and mild treatments for conditions: they desired complex and rough ones instead. Reading between the lines, it appears that Buchanan’s patients may have been loath to take the drugs he offered (111 are listed that he used) and especially to continue to do so after symptoms had subsided. The men he treated come across as part petulant children and part stoic adults in Buchanan’s description of their reactions to his care.

For Buchanan, adverse weather was the major reason for sickness among the regiment as it overheated or cooled the body, prevented perspiration and caused blockages in the body, or tired the soldiers out to the point that they came down with fevers. Rest, good air, a simple diet and light wines were the keys to maintaining health but this was often not possible in the circumstances of war, as reading the manuscript with Kopperman’s excellent annotations reveals. Food was scarce at times, sunburn played havoc with the faces of officers who would not uncock their hats to save their skin (as this was considered unmilitary) and high winds and dust caused an unrelenting wave of eye infections.