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tained by food and stimulants. Mr Treves, one of the consulting surgeons with the forces in Africa, gives a most vivid account of what he saw at such a place :–
"The scene presented at this spot was beyond description. The men were coming in as fast as ambulances and bearers could bring them. Some were dead, some were dying, all were parched with thirst and baked and blistered with heat. The men were lying on all sides on stretchers - amidst tents, piles of rifles, accoutrements, battered helIt mets, and blood-stained tunics. was a sight no one would wish to see the miseries of all." again, and the blazing sun added to
now we come to the work of another item of the system, the "bearer companies,' one of which is attached to each brigade of cavalry or infantry. In a great battle it would be obviously impossible for the surgeons attached to units to attend to all the men who are injured, the regimental stretcher - bearers could carry all from the field. More assistance is necessary, and this is given by a bearer company, consisting of three of three officers, nearly sixty non-commissioned officers and men of R.A.M.C., and thirty-eight men, under a warrant officer, of the Army Service Corps. But the dressing station is The major of the company only a halting-place. There it and another medical officer is impossible to keep any cases remain at the dressing station for prolonged treatment, and with the sergeant-major, three all are at once placed in the non-commissioned officers, four second line of ambulances for privates, and a cook, while conveyance to the "field hosthe remainder of the company pital." This is a large estabmoves after the fighting-line lishment consisting of a hunto help in tending and remov- dred beds, and is under the ing the wounded as they fall. charge of four officers and a The dressing station is estab- quartermaster, with thirty-five lished beyond the zone of non-commissioned officers and fire, and, if possible, near a privates R.A.M.C., and, in road and a good water-supply. addition, twenty non Buildings are utilised when missioned officers and privates available, but if not tents are Army Service Corps for transpitched; fires are lighted for port duty. A field hospital is heating water and preparing attached to every brigade or restoratives; everything that equivalent body of troops, and surgery requires is ready for it can, if required by circumuse, and medical comforts are stances, be subdivided into provided. It is here that sections of twenty-five beds. there is the first opportunity As it must accompany its briof minutely examining the con- gade on the march, it is to the dition of a wounded man. fullest extent mobile; but it is Here he is carefully attended so equipped and provided that to. Here immediately neces- it can remain in one place for sary operations are performed, a considerable period and give and here his strength is sus- to its patients every facility for
repose and comfort as long as they remain in its shelter. This is no long time, however. Being liable to marching orders at any moment, every case that can possibly be removed must be transferred at once to a "stationary hospital." As its name implies, this is a hospital which does not accompany the movements of the army, and is a fixture until there is a great change in the scheme of operations. It is placed on the line of communications, and all of its arrangements have a more or less permanent character. There are several stationary hospitals now in South Africa, and each contains a hundred beds; but it can be broken up into sections of fifty beds, complete in every respect. The personnel of each is nearly the same as that of a field hospital, with the exception that there is no transport equipment. No man is, however, placed in a stationary hospital if he is fit to undergo the journey to a 'general hospital" at the base of operations. General hospitals have been established at the great South African seaport towns, and they are the ne plus ultra of medical science and administration, hardly yielding in any single point to the great organisations at home. Each accommodates 500 rank and file and 20 officers, and is worked by a large staff, comprising a colonel, seven officers, and about 140 non-commissioned officers and men of the R.A.M.C., with eleven civilian surgeons, a lady superintendent, and eight nursing sisters. From the general
hospital there are only two moves possible for the patient
-one back to his native land, when he is, alas! permanently disabled or not likely to be fit for war for a considerable time; the other, and happily it is one that can often be made, when he is entirely restored to health and strength and is able to return to his duty in the ranks, very likely again to qualify for hospital treatment.
The long list of posts where sick and wounded are treated by no means exhausts the rôle of beneficent establishments under the direct charge and administration of the officers R.A.M.C. Besides the base depots and advanced depots of stores, medical comforts, &c., for which they are directly responsible, they have entirely in their hands the equipment and control of all the transport of patients by land and sea. No methods long prepared and framed in accordance with any practicable peace establishment could ever cope satisfactorily with the dire immediate necessities of a great battlefield, and the wise foresight of Colonel Gallwey, C.B., the principal medical officer with Sir Redvers Buller's army, made one of the most admirable provisions ever heard of in war's history. He organised a volunteer ambulance corps of 2000 men, who were told off in the proportion of 12 men to a stretcher. These stretcher-carriers bore all the more seriously wounded from the field in the Colenso fight, and thus spared them the suffering and danger which would have been inevitable from the
Creagh has made his hospital trains the object of unlimited labour and thought. In them, as soon as a patient has been put into his berth, he has been able to command iced sodawater and whisky, iced milk, hot soup, or even champagne and seltzer-water. In relation
jolting of the ambulance-waggons over the uneven ground. Not only did they do this all day, but during the following night and day they carried all the worst cases on to the stationary hospital. It was due principally to Colonel Gallwey's bold initiative and thoroughness of previous organisation to hospital trains it should that not a single wounded man be noted that Major Creagh was left on the field after dark. brought his train actually This is only one instance out of under fire on to the battlefield many that might be cited show- at Colenso, and that the ing what a practical grasp the wounded were lifted into it officers R.A.M.C. have of every- from the place where they fell. thing that bears on their re- Truly, if war is a brutal and sponsibilities, and how perfectly illogical business, at any rate prepared they are to foresee and some of its worst evils have meet necessities that may arise. been palliated by philanthropic science.
Then, for the long railway journeys from the front to the base, hospital trains of the most elaborate completeness in equipment were prepared before the necessity for their use actually arose, and have been found admirably adapted for their purpose. Each train is a selfcontained hospital, with stores, means of cooking, comfortable arrangements for patients, and room for medical staff. African railways are generally a single line of rails, so frequent shunting on to a siding must take place to allow other trains to pass; but from this there follows no inconvenience except the delay, and every precaution is taken that in passing from the battlefield to the general hospital there is no increase of hurt or suffering. Again the work on the Natal side may be quoted as an example of what has been done, but certainly only as a case of ex uno disce omnes. Major Brazier
In African waters there are now six hospital ships-the Trojan and the Spartan, which were provided by Government; the Princess of Wales, prepared by the Red Cross Society, assisted by funds given by the kind Princess whose name it bears from moneys remaining in her hands after the occupation of Egypt; the Maine, chartered and fitted out by the generous exertions. of American ladies, under the personal care and supervision of Lady Randolph Churchill; and the Lismore and Nubia, lately fitted out in the colony. These magnificently arranged and provided ships are under the direct control of the R.A.M.C., though it has been of course impossible to find, from its too limited numbers, all the professional personnel, and this has been formed from the cream of the medical faculty in England and the United States.
The normal requirements of an army in the way of medical attendance differ so enormously from the tremendous pressure of a great war, that it would be out of the question to maintain such a permanent establishment of the R.A.M.C. as would be sufficient to meet all the duties which now lie before it. Like those of other nations, our military medical department has always had to contemplate the necessity, when an emergency arose, of appealing to the medical profession at large for assistance. The appeal has now been made by the DirectorGeneral, and most nobly and enthusiastically has it been answered. Thousands of the most highly qualified men in our islands, representing all the great medical schools, have applied for employment, and the only difficulty has been to choose from the multitude the few hundreds that have been required. It is understood that these civilian surgeons are to receive the same pay and allowances during their term of employment as the regular officers; but no such temptations, nor indeed any temptations whatever, were necessary to secure their services. These gallant volunteers were only anxious to practise their noble profession in their country's service, not in mere commonplace hospital work, but in the most advanced posts, where exposure and hardship are greatest and the enemy's bullets are flying most thickly. So far it has not been considered desirable to gratify their very laudable ambition to the utmost, as
their lack of military experience and knowledge of military routine might present some difficulties, but they are finding ample employment in the base and stationary hospitals. It is by no means improbable, however, that the time may come when some of them may find themselves in situations which will very fully try their nerve and hardihood.
In addition to the regular working staff of our medical organisation for war, our soldiers are also having with them some of the greatest British surgeons as consultants. The names of Sir W. MacCormac, Mr Treves, Sir W. Stokes, and others who have gone to South Africa, are those of princes in their great calling, and England owes a deep debt of gratitude to such men, who, forsaking their great positions and largely paid practices at home, have gone forth on their errand of mercy. It is no confession of weakness on the part of the R.A.M.C. that it should welcome the advice in grave cases of scientists whose reputation is pre-eminent. The credit of its officers, gained brilliantly in peace and war, puts it beyond any such suggestion; but there is no doubt that it is often more difficult to decide whether a serious operation is advisable than to perform the operation itself, and it must be of the greatest satisfaction to the patient, to the patient's friends at home, and to the surgeon that the propriety of any course of action should be supported and fortified by an opinion of unquestionable weight and
value. If they had gone from England for nothing else but to inspect and report upon the R.A.M.C. work in the field and in hospital, the presence of the consultants in Africa would have been an immense satisfaction to the English people. No men know better than they what surgery and nursing should be, and when, as independent critics, they can and do pour forth unstinted praise upon every detail that has come before them, we can bless the arrangement that has given us their opinion. In employing these distinguished men, England is only doing what all great Continental nations propose to do in the case of war; but even in our own history we have seen a leading London surgeon hurry to the scene of a great campaign :
"The fact may not inappropriately
be recalled that Sir Charles Bell acted as a volunteer consultant to the forces after Waterloo. In his 'Letters, published by his widow, it is stated that when, on June 22, 1815, the news of the great battle reached London, Bell exclaimed to his brother-in-law, Mr John Shaw, afterwards surgeon to the Middlesex hospital: Johnnie! How can we let this pass? Here is such an occasion of seeing gunshot-wounds come to our very door. Let us go.' They set off at once, the only passports they thought of being surgical instruments these Shaw shook in the
faces of the officers, who thereupon let them pass without making any difficulty. On their arrival at Brussels they found things in some confusion. Bell writes on July 1: It was thought we were prepared for a great battle, yet there we are, eleven days after it, only making arrangements for the reception of the
Sir Charles Bell appears to
have given his great skill principally to the French wounded, though he was consulted by General Adam, Sir Edward Barnes, Sir Henry Hardinge, and other officers.
After all, surgery and medicine are not everything in the treatment of a case, but careful and tender nursing takes a very important part. The medical officer cannot always remain by one bedside, and if his directions are not minutely carried out during the long hours when he is employed elsewhere, his best skill will be but of partial avail. It does not appear to be usually known that the men of the R.A.M.C. are not only stretcher-bearers but are also highly skilled and experienced hospital attendants, and are divided according to their capabilities into various classes. The orderlies of the first class are thoroughly trained 'nurses,' while the others are employed as compounders, cooks, &c. Probably nowhere is the responsibility of nursing more felt than it is by the orderlies in a military hospital. Quite irrespective of the sympathetic feeling which we believe that most Englishmen have towards helplessness and suffering, they are very fully imbued with the military virtues of discipline and devotion to duty. We know well how in the combatant ranks good officers can by their leading incite their men to deeds of chivalry and heroism, and in like manner the unfailing scientific coolness, resource, presence of mind, and entire forgetfulness of self shown by the officers