men took part in any long and difficult march.' Last and most authoritative witness of all, the Director-General of the Army Medical Department stated in evidence at the close of July that he had not received in his official capacity any complaints of any special hospital.*

Here, then, we are face to face with a somewhat star ling administrative paradox. A medical service so unpopular as to be declining in numbers, in the standard of those who enter it, and organised only to supply some 50,000 men on active service, is called upon to meet the requirements of an army of far greater numbers. It is given only a week's notice for active preparations. It operates during many months in a country rife with typhoid. The campaign is so terrible that, excluding all those who pass through its hands and do not recover or who pass through its hands and return to the front, some 27,000 soldiers are invalided home. Yet at the end of this period the great official who presides over this department can state in evidence that not a single complaint of any single hospital has reached him. Who, then, tended the remaining 150,000 men, aud had any complaints reached any other quarter?

The crisis, so far as regards the inadequacy, recognised on all hands, in the numbers of the officers of the Royal Medical Staff, was met in the three following ways. First, every available officer was sent to Africa and their places in the home establishment filled by civil practitioners, secured by advertisement, and also by a certain number of retired pay officers of the Army Medical Corps. Secondly, the numbers of the Army Medical Corps were hastily increased to such an extent that not far from one out of every three officers who have been sent to South Africa are under two years' service, men, that is to say, of the smallest experience. Thirdly, civil practitioners were enlisted and despatched to the seat of war, so that, according to the most recent statements, against 466 army medical officers there are about an equal number of civil practitioners sent out by the State, and even this figure does not include the civil practitioners engaged by the State in South Africa itself. That such steps were absolutely necessary is illustrated by the fact that even when No. 1 General Hospital set sail on October 6, 1899, the complement of officers is, of course, very short of the regulation number, which will be made up as far as possible as more officers become available.' + * Times, July 26, 1900.

† Lancet, October 28, 1899, p. 1185.

Turning from the question of the supply of officers to that of the subordinate grades-namely, female nurses and male nurses, or in other words orderlies-here, too, a similar deficiency had to be met. Into the vexed question of the proper extent of the employment of female nurses during active operations it is not necessary here to enter. Although the traditions of the Army Medical Corps are opposed to female nursing, assigning nearly nine times as many male as female nurses to a general hospital, suffice it to say that at the present time almost all men, from Lord Wolseley and Lord Roberts downwards, recognise its desirability, more especially in the fever cases, which are the common scourge of young soldiers. According to Mr. Wyndham's latest statement there are 566 female nurses employed by the State in South Africa. According to Lord Wantage, writing at the same date, in the name of the Red Cross Society, of which he is Chairman, the Army Nursing Service Reserve, a private association presided over by H.R.H. Princess Christian, has supplied the War Office with 500 fully trained nursing sisters.' As regards orderlies, the State had nearly 5,700 at the date of the last official statement. How many of these have been provided by private agency it is impossible to state exactly. The Red Cross Society had provided 2,000 at that date, a large number of these having been recruited from the ranks of the St. John's Ambulance Brigade, a private body working in conjunction with the Red Cross Society. As the above figure of 5,700 includes other volunteers, such as those raised in South Africa to the number of five or six hundred, we should be much suprised to find that the State had provided many more than 2,000 orderlies fully trained by itself.

So far, therefore, as our examination has proceeded, some glimmer of light appears in the mystery before us. A corps organised to meet the needs of 50,000 men has to meet the needs of 150,000, and does so, according to the official statement, without a complaint being officially raised. The staff, at any rate, has necessarily to be provided very largely from outside the Army Medical Corps. But that is not all, or rather is a small portion of the whole. Not only have civilians supplemented the staff of the Army Medical Corps to an immense extent, but they have provided whole hospitals and equipment of their own. The private hospitals that have been sent out from England alone are ten in number accommodating upwards of two thousand patients, the best known being the Portland, which was the pioneer of the move

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ment and opened in South Africa on January 7, and the Yeomanry, which was the largest. It should be clearly understood that these hospitals were civil institutions, as is illustrated by the fact that these two staffs were composed entirely of civilians, except the head officer, who in each case was a member of the Army Medical Corps, appointed for official purposes and having practically little to do with the treatment of the patients. And how many beds were there altogether available, say in June, for our soldiers in South Africa? Mr. Wyndham stated it at 18,600 in June, which figures 'include everything in the shape of local hospitals.' At that time the beds provided by the Army Medical Corps were as follows: 27 field hospitals, accommodating 2,750 patients, though in reality field hospitals have no beds at all and only stretchers; five stationary hospitals accommodating 500 patients; and fourteen general hospitals, accommodating 7,560 patients. Total, 10,900 beds. The difference between 18,600 and 10,900 represents two things-first, the indebtedness of the State to private persons in respect of hospital accommodation; secondly, the concentration of fever and other patients to a number far beyond, and with a staff far less than, what is permitted or considered prudent by the Army Medical Regulations. Nor does this exhaust the matter. A vast amount of stores of all kinds have been provided by the various charitable societies, the chief of which is the Red Cross; not so-called 'comforts' merely, but such downright necessities as pillows, beds, and bandages, the necessary equipment of a hospital. A list of such provisions as supplied to the State hospitals by private enterprise might cause surprise in view of the official statement that only a few nail-brushes' were needed at the opening of the campaign, and that as the war proceeded stores have been piled up to an almost embarrassing degree.'

Hitherto we have been investigating a marvel and a mystery; a department, confessedly in deterioration, suddenly called upon to meet a crisis for which it was not organised, and facing it, as is alleged, without a flaw in its organisation or a complaint raised so as to meet official ears. One cause of this paradox has now been disentangled, the advent of civil aid to a degree quite unparalleled. But there are other causes. During the first four months of the war, until Lord Roberts's march on Kimberley and Bloemfontein in February, eight important battles were fought, four by Lord Methuen, one by General Gatacre, and three by General Buller. All these battles had three

common features-they were fought upon our own soil, their tactics were based upon the theory of the frontal attack, and they were all delivered either on, or close to, a railway. The advantages from a purely medical point of view of such tactics as those of the Modder, or Magersfontein, or Colenso, were great in the following sense. In each case trains were waiting to convey the wounded into the chief centres of civilisation, Cape Town and Pietermaritzburg, and thus no difficulties of transport or commissariat could easily arise, so that it was therefore perfectly open to all men to suppose that here was the one bright spot in the war.'

Another explanation of the mystery was that the sickness was for many months extraordinarily light. Until January, for instance, the health of Lord Methuen's force was extremely good, while at Colesberg General French's troops were healthier than at home. But the most authoritative and final statement made upon the point was that of Mr. Wyndham in the House of Commons on March 16. Do not let it go abroad,' he said, that there has been a 'great amount of sickness in South Africa. The percentage 'of sickness has been far lower than in any other case of 'which we have any record.' These words were uttered three days after Lord Roberts's army had entered Bloemfontein. Consequently, if the men up to that date had been healthy beyond parallel, then easy beyond parallel had been the task of the Army Medical Department. Thus we have said enough to show that until March a remarkable combination of favourable circumstances postponed any question as to the efficiency of our medical arrangements at the front. There was no test because there was no pressure; everything was 'perfect' because the hour of stress had not come.

6

And yet, such is the perversity of human criticism, even in those days here and there a voice was raised. Towards the closing days of December, we read in the Times: ' 'Complaints have been freely made for some time past ' about the military hospital accommodation at Cape Town; there is a want of organisation and foresight; the whole ' establishment was calculated on too small a scale; the number of nurses and orderlies is insufficient; it is absurd that the Army should depend on charity for sufficient 'food; there is a lack of a strong central organising head.' In the Guy's Hospital Gazette' appeared severe reflections on the management even of the hospital train after the battle of Belmont. The Times of Natal' also made certain criticisms on the Natal arrangements, which were, however,

6

at once stigmatised by the leading surgeon as unwarrant' able, mischievous, cruel, and false.' But these were solitary and jarring notes, lost immediately in oblivion, or swiftly condemned by authorities beyond appeal. Like the sudden cry of some animal in the wilderness, they came and went without a trace, and were followed by a silence profounder than before.

It was on February 12 that Lord Roberts left his camp at the Modder River, and with some 45,000 men commenced the movement which ended on March 13, a month later, at Bloemfontein. During that month, in spite of the terrible heat and drought, the health of the troops was excellent. But now that for the first time we no longer rested upon a railway, an essential weakness of our medical organisation was revealed. It had no transport of its own, and, transport being short generally, its equipment both as regards ambulances and bearer companies was cut down to one-fifth of that usually allowed. What happened? At the battle of Driefontein, for instance, on March 10, there were about 400 wounded and only four of our ambulances to serve them. The result may be imagined when it is stated that our ambulance-wagon, an antiquated affair, holds only two men lying down and three or four sitting up. The consequence was that the removal of the wounded to hospital was not finally accomplished until the middle of the succeeding day. Fortunately, the general situation was alleviated by the arrival of a private hospital, the New South Wales ambulance, which, having its own transport, proved invaluable. 'Without this field hospital,' as Mr. Watson Cheyne, the leading surgeon with Lord Roberts's army, has observed, 'the Army Medical Department would very often have been in 'serious difficulties.'* It is curious that at almost the same date the organisation of the Army Medical Staff in Natal was also undergoing its first serious trial. Here the staff, and not the transport, was being tested. On March 1 General Buller entered Ladysmith. Up to that time the health of the Natal field force had been excellent, but now, with the sick in Ladysmith and with the sickness caused by the hardships endured during the relief, heavy calls were made upon the medical staff. Yet so little provision had been made to meet such an obvious emergency that there is not a single field hospital in Natal which has its full complement of officers and men, most of them having lost

*Times, July 23, 1900.