This medal, sanctioned in 1846, was the first campaign award issued to all ranks with clasps, although clasps had been awarded on the Gold Crosses and Medals issued to officers for the peninsular Wars. The basic design of this medal set a precedent in campaign awards that has been generally adhered to ever since. Another unusual facet to this medal is that the name of the first battle at which the recipient was present is found at the bottom of the reverse; thus medals with one clasp are found to recipients who were at two actions, and so on. Those who were at all four battles for which clasps were awarded could only receive three clasps, and no clasp was issued for 'Moodkee', it being the first battle of the campaign. The 1845-46 Sikh War was a difficult one, as the Sikh army was well-trained and armed. As a result, British Casualties at the four actions were heavy. However, the campaign was short and concentrated, lasting only three months, and the Sikhs returned for a further conflict with the British two years later (see Punjab Medal 1848-49). The medal is found named in two main styles; to British troops, in thin, upright impressed capitals, a rather distinctive style notable for the use of colons instead of full stops; and to Indian troops in engraved running script. The list of casualties have been compiled from the Sutlej Medal Rolls held at the India Office Library. The list is by regiments and gives the nature of the casualty, date and battle in which incurred: Moodkee, Ferozeshuhur, Aliwal or Sobraon. Those invalided home are also identified.