[ Txz BRJTr NoV. 2 1907.] MEDICAL SERVICE OF TERRITORIAL FORCE. LMRDICAL JOURNAL 12X 243 = I always a very great avoidable wastage. It might surprise THE MEDICAL SERVICE OF THE some of his hearers to learn that in the first year of a campaign the wastage was as high as 70 to 80 per cent. of TERRITORIAL FORCE. the fighting force. He did not think it was thoroughly ADDRESS BY understood how large a part of that wa3 due to preventable disease, and it was by the work of the medical profession SIR ALFRED KEOGH, K.C.B., M.D., and the medical profession only that the strength could be DIRECTOR-GENERAL, ARMY MEDICAL SERVICES. maintained. In war there were really always two armies in the field. There was the effective army, the fighting arm, and the SIR ALFRED KiEoGH, K.C.B., Director-General of the Army army of the non-effectives, the men who from diseae Medical Services, on October 26th addressed a conference or injury had fallen out of the ranks and had been of medical men of Yorkshire, Northumberland, and handed over to the medical officers who were the Durham at the Philosophical Hall, on the men responsible for the whole of the non-effective Leeds, subject army. It was said sometimes, "0 don't bother about of the medical arrangements under the new territorial invasion; when they come we will all come in, you army scheme. will get plenty of doctors when war breaks out," but did Dr. J. E. EDDISON, of Leeds, presided. not all that he had dlsplayed in the diagram mean some Sir ALFRED KEOGH said that Mr. Haldane had, in training, did not it require that they should from time to relation to territorial army medical affairs, given him time keep up to date in those matters, that every medical what he might almost call a free hand, and he could man in the country should know what the Royal Army not use that free hand better than by giving the same Medical Corps did when it went to war? What was the freedom to his own profession. He was anxious to relation of the medical profession to the science and art of consult them and not to teach; he came to learn war P Briefly put this was the relation-the maintenance whether the proposals he intended to put for- of the fighting strength of the army. ward were reconcilable with the conditions of The department of sanitation in the field was abso- the profession generally and with the duties of civil lutely independent of the hospital department, and a trial life. He was aware that a considerable number of the system in Ireland and elsewhere had been so far present had probably devoted no attention what- satisfactory as to encourage continuance on those lines. ever to the great question of the relation of the Sir Alfred then described the science and art of medicine to the science -and art of war. Keogh constitution of That subject had been very thoroughly studied and the sanitary organization of the regular army, which may thoroughly worked out in the armies of the Continent. In be gathered from the following statement and the accom- England, probably on account of our greater security, the panying diagram. profession had not devoted very much consideration to the THE SANITARY ORGANIZA.TION OF THE REGIULAR question. There were, however, amongst them a large number of volunteer medical officers who had given much ARMY. time to the subject, and many of the things which he SANITARY EDUCATION. would have to say were thoroughly well known to them. A School of Army Sanitation has been founded at The whole organization of ths national army for home Aldershot. defence had had to be considered, and before putting At this school the following classes are formed: forward a scheme for the medical service it had been necessary to wait until matters which must very largely (a) Officers' classes of not more than 25 officers. The influence that echeme had been settled. In the meantime course should last four weeks and an examination be he had been in communication with large numbers of held at its termination. The lecture3 will embrace medical officers of volunteers all over the country. He the whole of the subjects mentioned in the manual of had consulted many members of the profession, and he sanitation. had endeavoured to meet their wishes in every possible (b) Classes for regimental non-commissioned officers and way. While he asked them to accept the scheme he put men to form regimental sanitary sections for instruc- forward, It might be modified in any way that was thought tion in the disposal of excreta and refuse, in camp proper. He was not going to dictate to his profession. cleanliness, and in sanitary police duties, to fit them Sir Alfred Keogh then showed 'and described the to perform these duties on active service. One non- accompany,ing diagram of the medical service provided commissioned officer and eight men per regiment, for the Expeditionary Force drawn up by Lieutenant- battalion, or brigade of artillery, will be trained. A class Colonel Bedford, R.A.M.C. Sir Alfred Keogh said that will not exceed 45 non-commissioned officers and men. the of Importance maintaining the field hospitals empty (c) Classes consistIng of not more than 25 non-com- was great, and many disasters had teen due to the fact that medical missioned officers and men, general duty seetion, units, in consequence eIf their not Medical being empty, had not been able to go forward Royal Army Corps, to bs instructed in prac- with the troops. The medical profession regarded tical sanitation in the field and In the duties of water that work as humanitarian, and would agree that sterilization. the proper medical units must be up to the Officers are examined, and those who gain 50 per cent. of the fighting line to succour men as soon as possible. But marks will be recorded as " passed." Those who gain 75 per he held that the main duty of the medical offier and the cent. will geta -special certificate in sanitation. main duty of the medical sevice throughout the army was, In addition throughout the garrisons general officers first of all, to remember that upon them depended in large commanding-in-chief arrange for at least one annual courEe measure the maintenance of the fighting strength o the of lectures in sanitation for officers. The lectures are given army in the field both by preserving its health and by exer- by the command sanitary officer, or bya selected officer of the cising the greatest possible supervision over the wastage. Royal Army Medical Corps. All officers who can be spared He was accustomed to tell the medical officers of the army attend these lectures. that they should not forget that In the field there was A manual of sanitation has been prepared and has been THE BRITISH 1 1244 MEDICAL JOURNALJ MEDICAL SERVICE OF TERRITORIAL FORCE. [NoV. 2, 1907.
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IS- Squadronr Imperialg YeornnryJ Mounted Infantry Battalion - 638All rankrs lOfficerl & 3 rank &file R.A.M.C.atached HorseArtllery Brigade - 688AAllrwanks w0 Genera l lJ lOfficer&3rank &fi R.A.M.C. attacked. Hosp! I II1 Field Artillery Brigade - 974 all ranks IOfficer&4rank&filel R.A.M.C. ettched. *ff Royal Engineer Units of different strongths * ArIOfficerevc& certainop,rank &LfiluprClmR.A.hM.C. attachedc II Army Servce Corps, Sappy Column &c. St30t l Ofi9cerl-certain-. -.-- Irank &Aie- -.- R.A.M.C.- - ...... - attached , -' Hap! Ficld Ambulance -10 0fficers& 241other ranks. R.A.M.C. &A.S.C. x (Total4 20) Cavalry FieldAmbulance 6 Officers& 114ARA.M. C. i m H (Total 6) &A:S.C.
s A Clearing Hospital -O8fffcers&80 other ranks R.A.AI.C )' 0 260 Beds. (Total 6) A Stationary Hopital -8Officers &80otiner ranks R.A.M.C. 200------cds (Total. 12)-, (17La,Nurse,)------.-I /,A4 General Hospital -2Z Officers & 143 other ranks R.AJ4f.C. 520 Beds (Total 1Z) (43LadyN eeaw Ambulance Train -Z Off Cars & J8 other ranks R.A.M.C. DIAGRARI OF UNITS OOBeds------6) - Lad - a 1 -.(Total -1(J ---l -- C"ONP OSIN- rn Hospital Ship-6 Officers &"8 er ranks R.A.M.C. EXPEDIrIONARY FORCE mm 6) Sundry on Z20Beds--- (Total. -- -1 (9Ia4 - uwae Gfonpr Reg;mental Units Base DepAtMedical Stores - 2 Officers & 8 other ranks R.A.M.C. Gnes of Coenv,unicatio0 omitted. 100 Miles of Railway, I certain Roads. p AdvancedDepdt Medical Stores-I OffcfrL&5other ranks R.A.M.C. Rai7way
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DIAGRAM OF SANITARY SERVICE WITH AN ARMY IN THE FIELD. BY LT. COL. M.W.RUSSELL,R.A.M.C. Su elillil ME^1 L9 ~~~~~~~~~~~~~~~~...-I- M& t- Imqpm 0 mmqpm mqmmm mqmm
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AN INFANTRY BATTALION. WITH ITS SANITARY STAFF.
I 060e00 oe0 A Ofificer,R.A.C. e N.C.O. PMen.R.A.M.C. *ReirmentaiMlen. 1 I z46I 4 2&ISDICAL4L~B~sXJoUxAL J MEDICAL SRRVICE OF TERRITORIAL PE)E. []FbV. 21, O" I issued to all concerned. Instructions and examinations will The diagram prepared by Colonel M. W. Russell, Deputy be primarily based upon this manual. Assistant Director-General, showed the actual disposition of the various units of the sanitary service with an army in the field-that is to say, an expeditionary force. The EXAMINATIONS OF COMBATANT OFFICBRS IN SANITATION. intention was to model the sanitary department of the After the 1st March, 1908, all lieutenants will be required to medical service of the territorial force upon the same lines pass an examination in sanitation before promotion to the as that of the regular army. The diagram as applied to rank of captain. A lieutenant may be examined without the territorial force would represent the oganization of a single army mobilized to resist invasion; there might, having attended a course of lectures. of course, be several such armies mobilized in different parts of the country at the same time. INSTRUCTION BY REGIMENTAL OFFICERS. The Sanitary Committee for War, which forms part of Officers of will instruction the scheme, was very important to the army. Alter every companies, squadrons, etc, give campaign there was always a commission of inquiry to to their non-commissioned officers and men in sanitation. find outwhere things had gone wrong. The reports pub- lisbed about the medical service and so on always seemed INSTRUCTION OF MILITARY OFFICERS AT THE STAFF tomake it quite clear that there was room for improvement. COLLEGE. He now proposed that instead of holding Royal Commis- sions after a war, or sending them out in the middle At the Staff College a course of 12 lectures on sanitation will of a campaign after things had gone wrong, it be given annually by a speclally-selected offloer of the Royal should go out with the troops at the beginning. Army Medical Corps. The Committee would consist of responsible gentlemen, and they would be required by their advice to pre- vent those things for which formerly the army had been INSTRUCTION OF CADETS AT THE ROYAL MILITARY ACADEMY, held to blame. If there was a foreign campaign during WOOLWICH, AND AT THE ROYAL MILITARY his period of office he would like to flood the fighting force COLLEGE, SANDHURST. with civil and military sanitarians, as this was a matter of At the Royal Military Academy and Royal Military College such enormous importance to the country. a course of ten lectures will be given annually, either by the What was the organization of the medical profession resident medical or a of for home defence? Mr. Haldane rroposed to maintain officer, by specially deputed offioer the the expeditionary force in a state of constant efficiency, Royal Army Medical Corps. The cadets of the senior division and, when that force had to go abroad, to ensure that only will attend these lectures. there should be in the country a well-organized army An examination in sanitation, based upon the official consisting of citizens who would undertake the responsi- manual, will be included, after the 1st March, 1908, in the bility of defending the country in case of invasion. It final examinations of cadets in the senior was quite clear the medical profession must be organized division. to carry out the same duties as were provided for in the overseas army. What was the actual position? In 1898, SANITATION IN WAR. during the Cuban war, the Americans mobillzed In Georgia, Florida, Pennsylvania, and Virginia an enormous Every tattalion is furnished wlth the establishment men- volunteer army, and in five months that army had 20,000 tioned above, and establishments are provided for sanitation cases of enteric fever. The British army had 40,000 cases at the base of operations as well as at important posts on the of enteric fever in three years in South Africa. The profes- lines of communication, where the conditions of life more sion in America was very much disturbed about the great prevalence of enteric fever in their volunteer army formed clo3ely approach those of a civil community. in 1898, and the American army was very active in that matter. There was an especial danger for volunteers in SANITARY INSPECTIONTCOMMITTEE. this respect. The volunteers came from their homes throughout the country, and it was quite easy to see that On mobilization being ordered a Sanitary Inspection Com- epidemic disease would soon break out if the most careful mittee will be formed for service in the field, consisting of a supervision were not exercised. Even without epidemics, combatant officer as president, a field officer, Royal Engineers, if there were 70,000 men-and that was not a large force- and a field officer, Royal Army Medical Corps, as members. encamped near Leeds, they would have in two or three days nearly 2,000 sick-ordinary sickness. If they glanced The committee will act under the orders of the general officer at the volunteer force it would be found that there were commanding-in-chief. serious gaps in the organization, and the scientific system which Mr. Haldane had brought into existence was The dutie3 of this committee will be- designed to fill these gaps. If the medical part of the organization were examined, it would be seen that with (a) To ascertain that sanitary appliances and materials of each battalion there were four or five or six medical officers, all kinds required for the army are forthcoming, and but there was not a single hospital in the volunteer that an adequate reserve is maintained. army. Where were the 2,000 sick to go to? Some would get well and go back, and some would have to go home. But what would become of the vast majority? There (b) To assist general cfficers and the Medical Service in were no hospitals to take them. Worse than that, there their efforts to maintain the health of the army by co- was not such a thing as an officer specially employed in ordinating not only the work of the different military sanitation only in the whole of the volunteer force. but also the military and the civil sanitary Sanitary science had its origin in the British army, and branches, Great Britain had always taken first place in the world in organizations of the country or area occupied. sanitation. Surely it was not right that the citizen army should be absolutely bereft of a body of men whose duty (c) To initiate schemes of general sanitation, and to serve it should be to maintain the fighting strength of the army as a board of reference for the solution of sanitary in the field. He thought it was the duty of everybody questions. who was responsible for those things to make an effort to remedy the defect. He recognized perfectly well that a large number of members of the profession who would (d) To visit and insp3ct stations occupied by troops, to gladly assist in time of trouble, and who would gladly advise local authorities regarding necessary sanitary asstit in time of peace if they could, had been excluded measures, and to further in every way the main- from the volunteers in consequence of the rules and tenance of satisfactory sanitary conditions. They regulations which had been in existence. He recog- nized that if a man joined the volunteers with the will report to head quarters any measures they con- object of learning tactics and strategy he must go up sider necessary, but which they cannot arrange for every year, and must do certain specific duties to locally. learn his new profession. But this principle did not MEDICAL SERVICE OF TERRITORIAL Nov. !29 "goM. FORCE. 0- 11247 I apply to the medical profession. What was wanted was the names of the experts. He wanted the hospitals to utilize the knowledge which medical men had in civil to be dignified institutions, consisting of the leaders life. It was the height of folly to aek a member of the of the profession in the different branches. He did not profession to go into camp for a certain number of days want to interfere with private practice or civil institu- to learn surgery and medicine. There were few of the tions, because civil institutions would have a great deal of leading physicians and surgeons in the volunteer army, work to do. It would be mere folly for him to come because as a matter of fact they were precluded by the exist- forward and ask men to join to proceed to any part of the ing rules regarding what was termed " efficiency," and yet country. Instead of sending the hospitals to the sick he they were perfectly efficient. But by the establishment proposed to send the sick to the hospitals, and he wanted of the hospitals which would be necessary for the terri- to know where the hospitals were to be. Was there to be torial force, it would be possible to employ a number of one at Leeds, Sheffield, and Newcastle respectively? The gentlemen as pure physicians and surgeons, and the number of the troops to be raised in that area was known, necessity for their going into camp does not arise. and the numbsr of medical units that should be raised Again, nothing had been done with regard to Banitation. was known. ThA whole country could easily be mapped The medical officers of health were very busy men, and it out and the sick sent to the great centres from certain was certain in time of invasion they would be glad defined areas. to place their great knowledge and experience at the He had no one else to appeal to but his own profession, service of the army, but there was no arrangement for there was no one else who could do the work. He for doing so, and it was time the army woke up asked them whether the system commended itself to in respect to this. Under Mr. Haldane's scheme them, or whether it did not. He asked them whether the country was divided into certain areas, and he they could form these hospital staffs and the sanitary wanted to suggest that, as in every army in the world, the branch, and whether they should not form one great medical profession should combine and form one great corps, studying in time of peace the great medical and organization, one great corps-a corps reflecting, as he sanitary questions which arose in war. There were many thought it should reflect, the organization of the regular difficulties and many details which had not yet been medical service on the lines he bad laid down. It would worked out. He did not think Great Britain was one whit then be possible to devise a system by which, when the behind any country in Europe in its capacity for organiza- regular army was out of the country and the regular tion, but there was a great deal to be done. medical service away, each individual would be able, in He had to apologize for putting himself forward in that case of invasion, to slip Into a place similar to one way; but he had the honour to be the head of the military formerly filled by a regular officer. Every one of those medical service in this country, and he would be very areas would be supervised by administrators and sanitary proud to think that anything he suggested would be officers. There should be in each of the areas a principal taken up by his profession. He could not go every- medical officer whose duty would be administration, where throughout the country, but he had gone to that Is, to co-ordinate the various branches in that area, certain central places, and he had chosen places where and in peace to make the necessary medical arrange- were situated the head quarters of his own corps. When ments for camps, manoeuvres, etc.; also a sanitary officer the medical profession had organized the corps and to supervise sanitation in the district. He recognized had developed it he hoped every year to go round to the that many medical men could not go into camp, being pre- centres where the work was being actively undertaken, vented by the exigencies of practice or even family affairs. and he proposed to hold conferences with those who were But an opportunity would be afforded for other medical interested in the matter, and with all who had joined, so officers to take their'places. Arrangements should be made, that they might endeavour to remedy any faults which whenever a volunteer corps assembled, for it to have a might be found. His desire was that the profession medical officer. He intended to ask medical officers of should regard him as absolutely at its disposal in the health to join the new corps and in time of war they matter. could arrange to relieve one another in their military The discussion which followed took the form of ques- duties. They would give technical advice to general tions, and in answering them Sir Alfred said every officers commanding and to the principal medical officers. battalion would have two medical officers and no more, They would supervise generally the sanitation of camps in and one officer would be bound to go into camp their own area, In thei vicinity of their own homes, and in every second year unless he had good reasons for not their own county. In an army of 70,000 there must be going. If he had good reason, his place could be filled sick people. If the authorities knew that Leeds, New- from the general body of the medical corps. In each area castle, and Sheffield had the personnel of great hospitals there would be a territorial army medical school. The ready-not civil but military hospitals-these would head quarters of the R.&.M.C. would be raised to the be places to which they could send sick and status of a school where officers would be able to get the wounded in case of invasion. In connexion with this "Ip. 8." certificate. He also proposed that the principal he was anxious that the physicians and surgeons in the medical officer should have aregular medical officer as astaff great centres in that area should become what he called, officer, and each corps school should have an adjutant from for want of a better term, "sa la suite" members of the the regulars. If a medical officer wished to remain with his territorial army. The term was well known on the regiment he could do so, or, if he preferred, he could join Continent, but an English name ought to be found. the R.A.M.C. field unit. The huts or buildings or tents He did not propose that these eminent physicians for the hospitals would be provided. He wished to find and surgeons should come out in time of peace, one cavalry field ambulance and six infantry field ambu- but they should be ready to act in time of lances in this area. These ambulances would have all invasion in and near their own towns. If the their own transport. In future all commissions would be country were invaded there would be great distress to what he hoped would be callei the Royal Territorial amongst the civil population. The profession would be Medical Oorps. An officer of the corps desiring to heavily burdened with work, the whole country would be be posted to any battalion could go to that suffering, and the contribution he asked the medical pro- battalion and stay as long as he liked. If he fession to make to a suffering country would be to burden wished to transfer to the sanitary department, or to themselves still further. He knew that in time of inva- join a hospital unit, or to go to the many staff openings, sion all members of the profession would come out, but he he could do so as opportunity occurred. Sanitation asked them to join the organization in time of peace. was a most important duty. Regimental stretcher Therefore he proposed to Invite the members of the bearers were matters for the commanding officers of great schools and Institutions in Leeds, Newcastle, and battalions, and would not be interfered with by this Sheffield to join the territorial medicrl corps as mem- scheme. bers who in time of peace would not be required to do On the proposition of Surgeon-Colonel DRAPER, anything whatever, but who in time of war would be seconded by Colonel WILSON, a vote of thanks was required to assist the sick and wounded of the territorial accorded to Sir Alfred, and a vote of thanks was also force. He wanted to form the hospital staffs, and he passed to the Chairman. wanted to know that the surgeons and physicians of Leeds The appended tables give full particulara of the pro- would join the organization. In order to make the condi- posed training, pay, and allowances of officers, non- tions easier, he asked for more names than were actually commissioned officers, and men of the Royal Territorial necessary, so that reliefs could be arranged. He wanted Medical Corps. r-- Tnz JBiLiTisia - 2 1248 KBDICAL JOURNALJ.1 MEDICAL RERVICE -OF TERRITORIAL FORCE.. LNOV. 19Q7..
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