Alfred Pennyworth has also provided first aid up to and including suturing wounds and removing bullets, as well as occasional tactical support. He is also able to perform arthroscopy and other advanced medical procedures, thus limiting, if not eliminating, the need for hospital medical treatment even in the face of grievous injuries, helping to maintain Batman's secret identity by ensuring that Bruce Wayne has no need to visit hospitals for wounds inflicted as Batman. Nevertheless, Batman still requires professional medical treatment when Bane breaks his back ("") and Hush's machinations result in his suffering a skull fracture (""). On these occasions, Alfred
Alfred Butler eventually rising to the rank of Captain. While a temporary Second Lieutenant, he was awarded the Military Cross. The citation reads: At the age of 17, Butler became a clerk to Henry Burke, then Somerset Herald. In 1919, on Burke's promotion to Garter Principal King of Arms, Butler became his secretary, and continued in this post until Burke's death in 1930. Burke specialised in genealogy, and Butler learned a lot from him, eventually being regarded as the foremost genealogist of his generation. During this time Butler also edited Burke's Peerage, from 1922 – 1926. Butler became an officer of arms