BRITISH MEDICAL SERVICES

Evening Post, Volume XCIII, Issue 101, 28 April 1917, Page 13

BRITISH MEDICAL SERVICES

STRIKING PROGRESS

When the full story of the wonderful achievements of the British Army during the past two and a-half years comes to be written, one of the most interest* ing chapters will be that devoted to its medical services (says a writer in the London Daily Telegraph). Not only have these expanded in a remarkable degree-' to cope with the rapid growth of the Army itself, but they have succeeded in dealing adequately with the many problems by which medicine and surgery were suddenly confronted as a result of the totally new conditions of modern warfare. In the main the operations of the medical services are not based upon a neworganisation ; xather they are the development of lessons learned from recent campaigns, chiefly those in South Afripa and Manchuria. How well founded were the underlying principles will be readily gathered, when ,it is remembered that upon thprn has been built, up a scheme which has satisfied the medical and surgical needs of more than 5,000,000 men in climates as varied as those of France, Mesopotamia, Egypt, and the Balkans. '

It was shortly after the South African Wai that the Royal Army Medical Corps was reconstructed. Viscount Midleton (then Mr. St. John Brodrick) and Sir Alfred Keogh- undertook the first great reform—the provision of a sanitary ser: vice,, a highly specialised branch, to deal with such preventable diseases as, for centuries, had proved the scourage ofarmies in the field. It will be remembered how terrible were the ravages of enteric fever alone in the South African War. The losses through disease in that campaign; exceeded those by wounds. > Following on this reform came the i formation of a Boyal _Army Medical Corps for service with the Territorial Force, and it is no exaggeration' tq say that to these reforms can be traced many of the great results in the -present campaign. It must be remembered that the vario-us medicai corps of our Colonial forces are modelled entirely on our own, and their methods differ' from ours only in so far as there may be special circumstances peculiar to the localities in which they operate. ! SANITARY^ SERVICES. The new sanitary service was- intended to give to officers and men some knowledge of the elements of sanitation, in order that they might best co-operate intelligently with the specialists in preventive measures against diseases. Regimental medical officers were, provided with assistants specially trained in sanitation duties. A* school of Army sanitation wag opened at Aldershot, and courses of instruction, were, arranged at Sand.hurst and Woqfwiph. Army medical organisation became a subject of study at the Staff College, and officers were required to pass an examination in this special subject ■ before promotion to the rank of captain. , How beneficial have been the results of this reform is readily seen from the work of the Royal Army Medical Corps in the present war. Water supplies have been most "carefully investigated, and where non-existent, have, 'with the help of the Royal Engineers, been created by the construction of wells and reservoirs or by piping water, from £ distance. ."■ Behind-the lines/there have been, mobile laboratories, .whilst at other places chemical and miscrbpic examinations and analysis have been quickly and readily obtained. With the aid of: the .'Medical Research Committee created by the National Health Insurance Act, numerous bacteriologists have been provided, and much scientific assistance has been given. In every field there is now established a committee of sanitary experts who travel from phjce to place and give advice on difficult questions. Tyuly astonishing have been the results of the creation of, this special department. Disease prevention has be^ com© almost a simple routine, and disease detection a question of certainty. Enteric' fever has been fought with extraordinary success, and in a country where local conditions are very unfavourable, where water supplies were not above suspicion, and where trench fighting, with all its attendant' evils, made the -outbreak of disease almos 1; a certainty. Areas once infected with enteric have been swept clear. Tetanus has almost ceased to exist, and other infectious complaints, Each as cerebro-spinal meningitis, have been easily held in" check. Thus the rate of sickness among troops has been on a low scale, the wastage through disease is considerably reduced, and the proportion of fit fighting men, stands higher than was anticipated. TERRITORIAL MEDICAL COBPg. In the reorganisation which followed the South African War, opportunity was taken to create a Territorial Royal Army Medical Corps in all respepts the counterpart of -the Regular Royal Army Medical Carps. At the same time a special corps was formed known as the Home Hospital Reserve, whose dnty it was to take over the military medical establishments at home when the officers and men of the .Regular Army Medical Corps were called for service with an expeditionary: force on the outbreak of wax. A'Territorial pursing Service was also formed. As a result of these arrangements there came into being; behind the Regular Royal Army Medical Corps another force trained exactly on the same lines. This second force was set in motion immediately on mobilisation, and so well had it been constructed that' it was easily adapted to meet the needs of the New Armies. To-day there are 10,000 officers and 70,000 non-commissioned officers and men in the Royal Army Medical Corps. The work of these officers, tlie large) majority of whom are in responsible positions, arid the work of the hundreds of medical men who have taken temporary commissions, is completed by numerous consultants, men at the head of their profession, who have left lucra- 1 tive practices to put their skill at the service of the military hospitals in Great Britain and France.

From the moment a soldier falls to the. time he is discharged from hospital ha is in the care of the medica,! service, though in the process 'of recovery he may have passed through advanced dressing station, field ambulance, casu-/ alty clearing station, motor-ambulancei ambulance touta, base hospital, convalescent camp, hospital ship, and home hospital. Rapidity of movement has become the characteristic feature in treating the wounded, and constantly men, on the very day they fall, find themselves in bed at a base hospital far down the lines of communication. ■

The collection of the wounded is one of tie most difficult, as it is the most dangerous, of the tasks of' the fioya-X Army Medical Corps. Frequently the discovery of men lying hidden in inaccessible -positions can only be undertaken at night. Once discovered and his wound roughly dressed, the man is carried back to a . dressing station—a place moderately.well sheltered, from shell and rifle fire—where a. medical officer attends. to his wound, and if an operation be necessary performs it. Antitetanus serum ie injected, and the man is given food and drink. Behind is the field ambulance which ■ collects sick and wounded from the regiments in front, and passes them further back at the first convenient moment. It J^ia thjesg ambulancea..that flom.§ r gj the

most striking changes were made after the South African War, and so excellent were these changes that the new organisation and equipment havft stood all the rigorous tests of warfare. In rear of the field ambulance is the . casualty clearing station, the wounded being brought there by motor ambulance convoys. Each convoy consists of 1 fifty cars* Cars of a particular make are collected together in order to simplify repairs and replacements, and with each convoy there travels a repair lorry fitted with a complete, workshop, with lathe, drilling machines, and other necea.sary tools, worked by electric power, and with complete electric lighting outfit. Though it would be impolitic to give figures, it may be stated that, despite the tremendous wear and tear of the traffic, there is a sufficiency of these convoys in all the seats of war.^

CLEARING STATION AND AMBU-

LANCE TRAINS.

The casualty clearing station is a link between the front and the stationary hospital down the lines. Though a mobile unit, it is equipped on such a scale that it is able to give mediqal and surgical aid in a manner approaching the completeness of a stationary hospital. It is in 'these clearing stations that the woundeel first come under the care of nursing sisters. Though sometimes housed in permanent buildings, more often the work is carried on und,er canvas or' in huts.. Frequently the stations have been near'enough to'the firing-line to come under shell fire. From the clearing, station, which is often established close to a railway line, the sick and wounded are^taken to an ambulance train. The railway companies have done everything possible to produce rolling stock fit to carry even the most desperately wounded. Each' train is a complete unit, with sitting-up accommodation for the slightly wounded, with luxurious accommodation for lyingdown cases, with' a special car for infectious cases, an operating theatre, a well-fitted kitchen, and quarters for the medical staff, the sisters, and orderlies. On 'the'way down the Unes of communication to the base hospitals there are stationary -hospitals where cases likely to recover quickly are treated. There aro also "convalescent depots for men who'are merely run down and require change, and rest Nothing could surpass the splendid efforts made at those convalescent depots to restore the men rapidly to health. _ Excellent as were the arrangements] for,ithe war for setting up.'military hospitals, so great have been the needs 01 the present campaign that it has been found, necessary to alter practically the whole iprevious conception of these units. Instead of 520 beds,, which each unit musjtered before, the equipment is now such as to deal with, over 1000 men. Though municipal biddings have been pressed into service as base hospitals, for the most part these Hospitals have taJien the form of huts. They have sprung up like mushrooms, but their organisation is complete in every, detail. There are central' buildings with anaesthetic rooms and operating theatreß, from which there radiate large wards well heated, and lighted with electricity. There are dental departments,- with dental surgeons specialising in jaw cases.' In ithe eye departments there are consultants and workshops^ where lenses can- ibe'groand' toariy prescription j The conversion of ordinary vessels into hospital ships has been one" of the wondera'of the war, with.their,w^rda and swinging; cot?, and their lifts in place of companion" ways. Here,- as elsewhere, it is' difficult to estimate at its true value the help .given by the British Red Cross Society, the St. John/Ambulance Society, and by a host of other svoluntary organisations. The medical' services frankly admit ithajt without this aid much of the work would have been crippled. The actual professional treatment of the sick and wounded would, doubtless, have been the same, b/ut there would have been lacking those comforts and luxuries for the wounded which have proved of such inestimable value. It would be almost impossible to enumerate all the public and private schemes which have helped in the work'of succour, and hone more i«adily admit their debt to this splendid voluntary effort that ths Army Medical Services themselves.