J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

·37

A WESTERN COMMAND R.A.M.C. STAFF TOUR. By COLONEL H. ENSOR, C.B., C.M.G., D.S.O.

THIS Staff Tour, of which I was the Director, was held on ·January 9 and 10 at as part of the winter training of the R.A.M.C. officers of the 42nd, 53rd and 55th Divisions of the Territorial Army. Excluding the Director, twenty-seven officers attended, which number included four regular majors, R.A.M.C., from the Northern Command, and the· Colonel on the Staff in Charge of Administration and A.Q.M.G. Western Command. . Some time previously the Director had given instruCtion in map reading to the R.A.M.C. officers of the above-mentioned divisions, and particular attention had been paid to the method now in use of identifying

points on a map. Protected by copyright. The Tour began at 6.30 p.m. January 9, when, all the officers having· assembled in the Conference Room, the corrected appreciations were given out to the officers who had sent them in. The Director then read out the appreciation he had written, which is given below, and gave his views as to how medical appreciations should be written. The officers were then formed into syndicates, and at 9 p.m. the same evening they again assembled, and a series of "tasks" were given to them, which, with the exception of Task No. 5, were based on the Narratives given out. .

Each syndicate having written out its solution of .the task set, handed http://militaryhealth.bmj.com/ itin for correction, and when all had been handed in, the Director stated what in his opinion was the correct solution . . The work done on the following day, January 10, is described later. The units given in the order of battle as mobilized for each corps of the Westland Army have been taken from the papers of the 1925 Western Command Staff To~r.. It will be observed that a field ambulance is given as one of the medical units of each corps. Unfortunately time did not permit of any discussion as to what the role of this field ambulance would be in battle. on October 2, 2021 by guest. The tasks s~t and the solutions made by the Director are given below, as is also a resume of the discussion which took place as to what disposi­ tions the officers commanding field ambulances of the 1st Division, West­ land Army, should make for the attack on the enemy position on January 10. At the close of this discussion the Director read out the R.A.M.C. Order for this attack, which he had written, and the Tour was at an end. The work handed in by syndicates was corrected and returned a few J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

38 A Western Command B.A.M.C.'- Staff Tour days later to the headquarters of the field ambulances of the 42nd, 53rd and 55th Divisions for the information of the officers concerned. My best thanks are due to my Chief Clerk, Qrmr. Serjt. P. J.Martin, R.A.M.C., and CpI. A. G. 'l'urner, R.A.M.C., for the very larg~ amount of work they carried out 'in typing and duplicating all the papers used in this Tour.

WESTERN COMMAND R.A.M.C. STAFF TOUR, 1926. Reference O.S. Maps 6, 1 inch, Sheets 60 and 70.

PRELIMINARY INSTRUCTIONS. An appreciation of the medical situation from the point of -view of D.M.S., West land Army, is to be written by, you and forwarded to D.D.M.S., Western Command, Chester, under confidential cover, by December 20, 1925. This appreciation is to be written on the supposi­ tion that the D.M.S., Westland Army, has been directed to forward one

to the Westland Army Headquarters on mobilization being ordered on Protected by copyright. December 9, the date on which hostilities commenced between the North­ land and Southland Armies. It is to be understood that armed interven­ tion on the part of West land in aid of Southland is imininent. Line of communication medical units are to be considered as about to be mobilized on the scale given in R.A.M.C. training, except that in the place of the two stationary hospitals, two general hospitals, each of 600 beds, will be mobilized for each division of the West land Army, and, also, two general hospitals, each -of 1,200 beds, in place of the two general hospitals mentioned in R.A.M.C. training. It may also be taken for granted that a convalescent depot (2,000 http://militaryhealth.bmj.com/ men) will be mobilized, if considered necessary, for each corps of the Westland Army. The question of transport of sick and wounded by hospital ships does not apply to this scheme, and the requirements of the two defence divisions of the Westland Army are not to be _considered. - It is to be understood that all sick and wounded of Westland Army are to be evacuated to selected places in Westland. The appreciation should be short and concise. Nothing should be mentioned in it except such matters as the WestlandArmy Command will wish to know concerning the medical problem. The character of the country in which operations on October 2, 2021 by guest. are expected to take place, and its resources, roads and railway communica­ tions are, for instance, already known to Army Headquarters, and need not be mentioned. Th~ hospital requirements for sick and wounded of the Westland Divisions and corps troops are to be carefully estimated, the .information given on these points in R.A.M.C. training being taken as a guide. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H. Ensor 39

GENERAL IDEA. (1) Northland (capital York) and Southland (capital London)" two powerful countries, are at war, hostilities having commenced on Decem­ ber, 9, 1925. The southern boundaries of the counties of Lancashire and Yorkshire represent the frontier between these two countries. Westland (Wales and Monmouthshire, capital Swansea), mobilized her army when hostili ties commenced between Northland and Southland, ostensibly with the object of maintaining her neutrality. (2) The initial fighting between N orthland and Southland has gone much in favour of Northland, whose troops advanced into Southland across the Lancashire-Cheshire frontier and, by January 5, had succeeded in forcing the Southland forces to retire on Whitchurch-Stoke-on-Trent. The wi~hdrawal of the Southland forces was an orderly one and nothing approaching a decision has been obtained by Northland. (3) The Northland Army consists of six corps, each of two divisions,

and a cavalry division. Of these forces, three corps are on the Yorkshire Protected by copyright. frontier, and two corps, and the cavalry division, engaged in the advance into Southland over the Lancashire-Cheshire frontier. The remaining corps is in reserve in the Chester-Tarporley areas. Southland's Army is made up of five corps, each of two divisions, and a cavalry division. Of these forces, two corps, and the cavalry division (less one brigade) are opposed to the three N orthland Corps on the frontier of Yorkshire; two corps, fI, division, and a cavalry brigade are holding the line· Whitchurch-Stoke-on-Trent. The remaining' corps (less one division) is in reserve about Lichfield.Westland's Army con­

sists of two corps, each cif two divisiops, and of two defence divisions. http://militaryhealth.bmj.com/ which are poorly equipped as regards artillery and transport. Westland is weak in cavalry, only possessing two cavalry regiments whose role iR i that b£corps cavalry. (4) On January 3, 1926, Westland"declared war on N orthland, In alliance with Southland, and on that date her Army was disposed as follows:- Army Headquarters Cardiff. 1st Corp~. Headquarters Builth. 1st and 2nd Divisions Radnorshire. on October 2, 2021 by guest. 2nd Corps. Headquarters Newport. ord and 4th Divisions Monmouthshire. Defence Divisions. 1st Defence Division ;Denbighshire and Flintshire. 2nd Defence Division Montgomeryshire. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

40 A WesteTn .Oommand, B.A.M.C. Staff Tour

(5) It was decided as a result of a conference between the Southland and Westland commands to employ the 2nd Westland Corps in support of the left of the Southland Army, and the 1st Corps in an attempt to envelop the right flank of the N orthland forces. (6) The forces of Northland, Southland and Westland, with the exception of the two Defence DivIsions of Westland, are to be considered as organized and equipped in accordance with British War Establishments, Small Wars, Parts XXIIIA, XXIVA, XXVA, and XXVIA, so far as lines of communication and base medical ,units are concerned. The sole object of the tour is to .consider the medical arrangements of, an army on active service" and in consequence the scheme has been arranged with that object, and no other. The order of battle of the Westiand Army, which is the Army whose medical arrangements will be considered, is attached, the compo'sition of the 1st Division is also given ,in detail. The medical arrangements for the two Defence Divisions·of Westland's

Army will not be considered. It, is to be imagined that they will be Protected by copyright. provided by the voluntary aid detachments of the counties in which they are operating. The medical arrangements for the Air Force of Wmltland's Army will, also, not be considered. SPECIAL IDEA. Reference O.S. l11ap, Sheet 70. At noon, on January 7, the situation of the Westland Army was as follows :- 1st Corps.

Headquarters, Knighton (sq. C. 33). http://militaryhealth.bmj.com/ 1st Division. Ludlo~ (E.' 65)-Bromfield(E. 38)-Onibury (Z. 00) areas. Divi­ sional Headquarters, . Medical Railhead, Knighton. 2nd Division and 1st Corps Cavalry Regiment. (K. 52)-Bishop's Castle (S .. 70) areas. Divisional Headquarters, Clun. Medical Railhead, Knighton. 2nd Corps. . Entraining for Wolverhampton-Dudley areas.

The 2nd Defence Division has crossed the Westland-'-Southland frontier on October 2, 2021 by guest. and is in occupation of the high ground east of Welshpool (Long Mountain and Breidden Hill (O.S. Map, Sheet 60).

ORDER OF BATTLE.-\VESTLAND ARMY. Army Headquarters. 1st Corps.-1st Division., 2nd Division. Corps Troops. 2nd Corps.-:-3rd Division. 4th Division. Corps Troops. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H. Ensor' 41

ht CORPS HEADQUARTERS. COrpS Cavalry.-lst Cavalry Regiment. Corps Artillery.-Headquarters Corps Medium Artillery. Two Field Artillery Brigades. Two Field Artillery Brigades Ammunition Columns. Two Medium Artillery Brigades. One Anti-Aircraft Artillery Brigade. One RA. Survey Oompany. Engineers.-Two Army Troops Companies. One Field Survey Company. One Electrical Mechanical Company. One Anti-Aircraft Searchlight Battalion. One Anti-Gas Laboratory and Demonstration Unit. One Workshop and Park RE. One Light Bridging Park RE. Signals jar R.A.F.-One Wing H.Q. Signal Section. Six Squadrons , Signal Sections. One Balloon Signal Section. One Aircraft Park Signal Section. . Signals.-One Corps Signals. Two Field Brigade RA. Signal Sections. Two .Medium Brigade RA. Signal Sections. One A.A. Signal Section . . Tanks.-Two Battalions Royal Tank Corps. One Tank Salvage Company. Supply and Transport.-Two Divisional Mechanical Transport Companies. Protected by copyright. One Corps Troops M.T. Company. One Med. Art.iUery M.T. Com­ pany. One Reserve M.T. Company. One Advanced M.T. Vehicle Reception Depot. One Auxiliary H. T. Company. Two Railhead Supply Detachments. Medical.-One Field Ambulance. One Sanitary Section. Two Casualty' Clearing Stations. One Advanced Depot of Medical Stores. One Motor Ambulance Convoy. One Mobile Hygienic Laboratory. One Mobile Bacteriological Laboratory. 01'dnance.-Two Ordnance Mobile Workshops (Light). One Ordnance Mobile Workshop (Medium). One Ammunition Company. One http://militaryhealth.bmj.com/ General Stores Company, One AntJ-Gas Mask Repair Shop. jVeterinary.-One Veterinary Evacuating Station. One Advanced Depot Veterinary Stores. Provost.-Two Provost Companies.

2nd CORPS. As for 1st Corps. " 1st Division. 1st Divisional Headquarters. on October 2, 2021 by guest. "'/ 1st Infantry Brigade.-Brigade Headquarters. "A" Battalion. " B" Battalion. " C" Battalion. " D " Battalion. 2nd Infantry Brigade.-Brigade He~dquarters. "E" Battalion. " F "Battalion. " G" Battalion. I" H " Battalion. 3rd Infantry Brigade.-Brigade HeaClquarters. "K" Battalion. " L" Battalion. " M" BattaJion.1 " N" Battalion. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

42 A. Western Oommand. B.A..M.O. Staff Tour

Headquarters 1st Division Artillery.-10th, 11th and 12th Field Artillery Brigades. 1st Pack Brigade. 1st Divisional Ammu­ nition Column. Headquarters 1st Division R.E.-10th, 11th and 12th Field Com­ panies R.E. 10th Field Park Company R.E. 1st Divisional Signals . . 1st Divisional Train. 7th, 8th, 142nd Field Ambulances. 1st Divisional Sanitary Section. 1st Mo bile Veterinary Section. 1st Provost Company.

NARRATIVE No. 1. Reference o. S. Map, 1 inch, Sheet 70. Protected by copyright. Information was received at Headquarters 1st Corps, at 10.00 hours January 7, that the enemy at. daybreak, on J~nuary 6, attacked the left of Southland forces about Whitchurch, employing important fre·sh forces. The result has been that the left of Southland's forces, to avoid en:velop­ ment, retired in the night in the direction of Market Dray ton, thus uncovering Shrewsbury. Definite information has also been received that the enemy have occupied Wrexham and Ellesmere, our defence forces being quite unable to oppose them effectually. There is· an unconfirmed r·eport that enemy cavalry occupied this morning. http://militaryhealth.bmj.com/ Air reconnaissances report· that a large column of the enemy is advancing in the direction of Shrewsbury from Ellesmere. This column is estimated to consist of a brigade of infantry, with artillery. Orders were issued from 1st Corps Headquarters, at noon, January 7, to the effect that the 1st Division was to march at daybreak, January 8, on Shrewsbury and the 2nd Division and 1st Corps Cavalry Regiment at the same hour on vVelshpool (M. 88) via Church 8toke (S. 25). The 1st Division is to march on Shrewsbury in two columns.· One column composed of the 1st Infantry Brigade, 10th Field Artillery on October 2, 2021 by guest. Brigade, 10th Field Company, R.E., is to make use of the road to Shrews­ bury via (Y. 83)-Horderley (Y. 68)-Wentnor (T. 34). The second column censisting of Divisional Headquarters and the remaining troops of the 1st Division is to march via Craven Arms and (U. 04) on Shrewsbury, the 2nd Infantry Brigade being the leading Infantry Brigade. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

. H. Ensor 43

DISPOSITION OF 1ST DIVISION UNITS AT NOON, JANUARY 7. , Reference O.S. Map, 1 inch, Sheet 70. 1st' Division Headquarters 3rd Infantry Brigade 12th Field Artillery Brigade . 12th Field Company RE. 10th Field Park RE. 7th Field Ambulance Ludlowarea (E. 65). 8th Field Ambulance 142nd Field Ambulance 1st Divisional Sanitary Section 1st Mobile Veterinary Section 1st Provost Company 2nd Infantry Brigade 11th Field Artillery Brigade ::: I Bromfield- 1st Pack Artillery Brigade ::: f areas (E. 38 and E. 59)., Protected by copyright. 11th Field Company RE. 1st Infantry Brigade ... \ Onibury - 10th Field Artillery Brigade 10th Field Company RE. ::: ,areas (Z. 00 and D. 59). 1st Divisional Ammunition Column (D. 55). 1st Divisional Train Brampton Bryan (D. 23)

DISPOSITION OF 1ST CORPS MEDICAL UNITS AT.· NOON, JANUARY 7. Reference O.S. Map, 1 inch, Sheet 70.

1st Corps Field Ambulance, less" A" Company Builth. http://militaryhealth.bmj.com/ " A " Company 1st Corps Field Ambulance .. ·1 No. 2 Casualty Clearing Station (open) :::1 Knighton. N 0 .. 1 Casualty Clearing Station (closed), ... 1st Corps Sani'tary Section Builth. No. 1 Motor Ambulance Convoy ." t Knighton. No. 1 Advanced Depot of Medical Stores ...... )

NARRATIVE No 2.

Reference O.S. Map, 1 inch, Sheet 70. on October 2, 2021 by guest. (1) The 1st Division marched at daybreak, January 8, in two columns and by 16.00 ·hours, January 8, had halted for the night in the following areas :-:- Right Column. Little Stretton (T. 92)- (T. 90)- (Y. 98)- (Y. 86) areas. 1st Divisional Headquarters, Felhampton Court (Y. 9986). J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

44 A WesteT1~ OommandR.A.M.O. Staff Tour

2nd Infantry Brigade Headquarters, Manor House (T. 9518). No. 8. Field Ambubnce, Mill at T. 9615. '3rd Infantry Brigade Headquarters, Inn at (Y. 9876). ' No. 142, FieldAmbulance, Hall at (Y. 9868). Left Column. Norbury rr. 14)-Wentnor (T. 34) areas'. 1st Infantry Brigade Headquarters, Wentnor Rectory (T.3838). No. 7 Field Ambulance, School at T. 2435. Owing to the sparsely populated district it was found impossible to billet all the troops; many units of the right column were obliged to bivouac. The weather was dry and cold, but foggy. (2) Information was received at 1st Division Headquarters, at 23.00 hours, January 8, that enemy cavalry occupied Shrewsbury at 16.00 hours, January 8, without opposition. The bridges in and near Shrewsbury

have not been destroyed and are now held by the enemy. ' Protected by copyright. Air reconnaissances were attempted during the day but, owing to fog, no information of value could be obtained. (3) The A.D.M.S., 1st Division, was informed on the evening of January 8 by D:D.M.S., 1st Corps, that No. 1 Casualty Clearing Station would move by rail from Knighton on' the morning of January 9 and would open for the reception of sick and wounded at Horderly (Y. 68) at 18.00 hours the same day. No. 2 Casualty Clearing Station will close at Knighton at 18.00 hours, January 9, and proceed by road to Welshpool under arrangements made by

the" Q" branch of Westland Army .. http://militaryhealth.bmj.com/ No. 1 M.A.C. is also to move to Horderley on January 9 as also is " A " Company 1st Corps Field Ambulance. It will be seen from the above that the Medical Railhead of the 1st Division will, on January 9, move from Knighton to Horderley .. n.M.S., Westland Army, as a result of representations made to him by D.D.M.S. 1st Corps, has ordered pne section of his reserve motor ambulance convoy to report to him for duty. This section on arrival will be sent to Welshpool.

NARRATIVE No. 3. on October 2, 2021 by guest. lteference O.S. Maps, 1 inch, Sheets 60 and 70. The march of the 1st Division was resumed at 09.00 hours, January 9, an earlier start being impossible owing to dense fog, which lifted but little throughout the day. Much delay later was also caused by enemy cavalry, estimated at a squadron, being met with in, occupation of the villages of Longnor and Micklewood (squares P. 41 andP. 32, sheet 60), J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H. Ensor 45

,the advanced guard being forced to deploy to deal :with them. The enemy cavalry retired as soon as th6 deployment of the advanced guard was completed. Our casualties were two killed and eight wounded. . By 17.00 hours, January 9, the 1st Division halted for the night and the troops were disposed as follows:- Right Column. Dorrington (P; 34)-Great and Little Ryton (p. 44)­ Frodesley (P. 72)-Longnor (P. 41)-Leebotwood (D. 39)- (U. 16)-Church Stretton (V. 04) areas. ,Divisional Headquarters, Dudgeley House (D. 27). Headquarters, 2nd Infantry Brigade, Longnor. "E " Infantry Battalion, Dorrington. " F "" "Great and Little Ryton. " G "" "Frodesley.- "H"" "Netley area (P. 23) . . No. 8 Field Ambulance, Leebotwood.

Headquarters, 3rd Infantry Brigade, All Stretton. Protected by copyright. No. 142 Field Ambulance, Church Stretton. Left Column. (0. 84)-Castle Pulverbatch (0. 73)­ Cothercott (0. 72) areas. Headquarters, 1st Infantry Brigade, Inn at Castle Pulver- ' batch. No. 7 Field Ambulance, Cothercott. The 1st Corps Cavalry Regiment advanced from Welsh pool towards Shrewsbury early this morning (January 9), and reported that at 14.00 hours to-day it was in action with superior forces of enemy cavalry west

of Yockleton (J; 51). It has taken up billets for the night as follows:- http://militaryhealth.bmj.com/ Headquarters and two squadrons, Westbury (J. 10). One squadron (less onetroop), at Minsterley (0.36). One troop, Habberley (0. 54). - Aerial reconnaissance was impossible all day owing to the fog. , The information gathered from refugees is that enemy forces, said to consist of cavalry and artillery, hold (0: 88)-Longden (0. 97)-:­ Exfordsgreen (P. 17)- (P. 56). It is known, however, that enemy' in,fantry were on the march on Shrewsbury from Ellesmere on

January 8, and they have probably arrived at Shrewsbury to-day. on October 2, 2021 by guest. NARRATIVE No. 4. During the night, January 9th to 10th, the fog cleared and patrols of the right column reported much movement in Condover village and also the sound of transP9rt on the -roads to the north of it. Several encounters ,with enemy 'patrols occurred in Condover Park, but 'no prisoners were taken. ' - J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

46 A Western Command B.A.M.C. Staff Tour

Stapleton (l;>. 25) was found to be unoccupied by the enemy as also the high ground to the eaRt of it; which was occupied by a company of "E" J?attalion, 2nd Infantry Brigade, about 19.00 hours, January 9. The left column reported that their patrols were fired on from the direction of Longden Manor (0. 86). It is certain from information obtained that the enemy is holding the following line:- Longden Manor-Long'den-Exfordsgreen-Condover. It is also certain that the enemy has been re-inforced by infantry estimated at a brigade. Orders were issued by 1st Division Headquarters that the enemy was to be attacked t9-morrow, January 10. The 1st Infantry Brigade is ordered to attack the enemy line Longden· Manor-Exfordsgreen .(ex­ clusive); the 2nd Infantry Brigade to attack the line Exfordsgreen­ Condover: The Colonel Commandant, 3rd Infantry Brigade, also received orders to send two battalions to Frodesley in readiness to advance to-morrow, January 10, to outflank the enemy's position at Condover Protected by copyright. from the east. It is of the greatest importance that Shrewsbury should be occupied by Westland's forces as soon as possible, as any delay in doing so will give Nodhland time to reinforce the troops that are in possession of it. On this account the attack on January 10 is to be delivered with the utmost resolution.

NARRATIVE No. 5. On receipt of the orders from 1st Division Headquarters, mentioned in Narrative No. 4, Colonel Commandant, 1st Infantry Brigade, issued orders for the attack on January 10 to the following effect:-. http://militaryhealth.bmj.com/ " A" Battalion, supported by "B" Battalion, to capture Longden Manor and park, and later to occupy Plealey. " C" Battalion to advance east of the main road to Shrewsbury to demqnstrate against Longden and Exfordsgreen. " D" Battalion to remain in brigade reserve north of Castle Pulver­ batch. The advance is ordered to begin at 07.00 hours January 10. The orders issued by Headquarters, 2nd Infantry Brigade, were as follows :- on October 2, 2021 by guest. " E" Battalion, less one Company in occupation of high ground to east of Stapleton, to demonstrate in the direction of Exfordsgreen. " F" Battalion, supported by "G" Battalion, to attack Condover. " H" Battalion to move into brigade reserve north of Longnor. The advance of the battalions to begin at 07.00 hours January 10. ""i The two battalions of the 3rd Infantry Brigade ordered to proceed to J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H., Ensor 47

Frodesley; received orders to march off to this place at 04.00 hours, January 10, and to advance to outflank the enemy position at Condover at 06.00 hours.

RAILWAY MAP.

IRISH SEA

CARNARVON BAY Protected by copyright. c CARDIGAN BAY http://militaryhealth.bmj.com/

• BRISTOL CHANNEL

It is to be assumed that the railway line from KNIGHTON to LLANELLY ancfthat via BRE.CON to SWANSEA is'a double one. on October 2, 2021 by guest.

Information was received at 1st Division Heac1quarters that the 2nd IDivision, 1st Corps, is advancing on Shrewsbury from Welshpool, and is :expected to ~ngage ,the enemy troops covering Shrewsbury from the west about midday, January 10. This 'information has been transmitted to the troops. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

48 A Western CommancZ R.A;M.C. Staff Tm~r

ApPRECIATION OF THE MEDICAL PROBLEM FROM THE POINT OF VIEW OF D.M.S., WESTLAND ARMY. The Westland Army, exclusive of lines of communication pnits, is composed of four infantry divisions and of corps troops. The officers and other ranks of the four divisions total 2,764 officers and 66,776 other ranks. The corps troops of the two corps amount to 1,246 officers and 27,130 other ranks. The sum of these figures' gives a total of 4,010 officers,and 93,906 other ranks, i.e., medical arrangements will be required for the sick and wounded of 97,916 officers and other ranks which number, as stated above, does not include the personnel ~f such lines of communication units as may be mobilized. For the sake of convenience in calculation, this number 97,916 will be taken as 100,000 in estimating the probable admissions to hospital of the sick and casual wounded. The campaign which is imminent will be one of rapid movement, at any rate in its early stages; and the fighting will be that incidental to open warfare. The time of the year is mid-winter, and the weather may be Protected by copyright. confidently expected to increase the normal number of sick, particularly the cases of respiratory diseases. The bombing of troops on the line of march· by hostile aircraft, even when contact with the enemy is not to be expected, may, with certainty, be considered as a fertile source of casualties. For these reasons it may be taken as a fact that the usual estimate of the numbers of sick and casual wounded, which will -daily require hospital treatment, will be very largely exceeded. This usnal estimate is that out of every 1,000 men, three men will daily require treatment in hospital. It is estimated that it will be neces­ sary to increase this number (3 per 1,000), for -the reasons given above, and my calculations are based on the assumption that five men out of http://militaryhealth.bmj.com/ every 1,000 will daily require hospital treatment. This means that 500 men daily will be admitted to hospital from the 100,000 men forming the divisional units and corps troops of the Westland Army. , The Army is well protected against smallpox and it is now some years since any cases of typhus fever have been recorded from our population. The time of . the year is against the prevalence- of fly-borne diseases, and, so long as the orders with regard to the chlorination of drinking water are complied with, water-borne diseases will be negligible .. on October 2, 2021 by guest. It has been stated above that 500 men daily may be expected to be admitted to hospital from the 100,000 men forming the divisional units and corps troops of the Westland Army. If it be assumed that 40 pet cent of men admitted to hospital are discharged fit for duty in seven days, and that 50 per cent require twenty-one days'. treatment, and -that 10 per cent may have to be treated in hospital for an indefinite period, it will J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H. Ensor 49 mean that by the end of the twenty-second day there will be 7,300 men in hospital, which number is likely to increase by about fifty daily. (See Appendix to this Appreciation.) It is to be understood that this number, 7,300 in hospital by the end of the twenty-second day after operations commence, is caused by the daily admissions of sick and casual wounded from the divisions and corps troops, alone; it is not the result of the troops being engaged in battle. , The battle casualties to be expected can be estimated as ten per cent of three-fifths of the number of troops engaged, so far as' divisional units are concerned, and ten per cent of one-fifth of the total number of corps troops. In the case of both divisional and corps units, twenty per cent of the casualties may be considered as killed, or, missing, and will require no medical arrangements. In the event, therefore, of the whole of the Westland Army being engaged, it can be estimated that the casualties from iiivisional units will be the following :- Ten per cent of three-fifths of 69,540 (41,724) = 4,172 casualties, less' Protected by copyright. 834 killed, or missing, = 3,338 wounded from divisional units requiring hospital treatment. Those from corps troops will be:- Ten per cent of one-fifth of 28,376 (5,675) = 567 casualties, less 113 killed, or missing, = 454 wounded from the corps troops. These two numbers--c-3,338 and 454-together make a total of 3,792, which may be taken as the number of wounded to be accommodated after the first general action with the enemy has occurred. In the estimation of the battle casualties given above, no account has been taken of the possibility of the enemy making use of poisonous gases. Their use, as is well known, is now forbidden by the League of Nations, but that most http://militaryhealth.bmj.com/ certainly does not make their use impossible-far from it. In the event of gas being used our battle casualties may possibly be much more severe. The time of the year is, however, not favourable, to" the use of mustard gas-the gas most to be feared. It will be seen from the above that, supposing a general action in' which all our divisional units and corps troops are engaged should occur" on any day after the twenty-second day from the commencement of hostilities, hospital accommodation for at leagt 11,000 officers and men will be required, a large number, which will be materially increaSed if gas is on October 2, 2021 by guest. used by the enemy. Also more, than one general action may be expected to occur in the course of the war. The campaign ~ill, in its early stages at least, be one of rapid movement, and in consequence no sick and wounded requiring more treatment than "medicine and duty" should be retained with units.' The field ambulances and casualty clearing stations must, also, not retain men who are not fit for full duty a single hour more 4 J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

50 A Western Command B.A.M.C. Staff Tour than is absolutely necessary. The lines of communication will not be long, and no difficulty should occur in returning men, discharged as fit for duty, from the hospitals to their units. . It is understood that regimental medical establishments, field ambu­ lances and sanitary sections will be mobilized for the service of the divisions in accordance with the existing war establishments, and that the same applies with regard to the regimental medical establishments of such units of corps troops as are in possession of them. The question of the number of non-divisional and lines of communica­ tion medical units to be mobilized will now be briefly considered: It is recommended that each corps should include as part of its corps troops the following non-divisional medical units :­ One Field Ambulance. One Sanitary Section. Two Oasualty Clearing Stations. One Motor Ambulance Oonvoy. One Advanced Depot of Medical Stores. One Mobile Bacteriological Laboratory. Protected by copyright. One Mobile Hygiene Laboratory. .. With regard to lines of communication medical units, the provision of the following is strongly recommended as a minimnm which will almost certainly require to be augmented in the event of the war being prolonged beyond three' months. General Hospitals (1,200 beds) 8 General Hospitals (600 beds) 8 Hospital for Venereal Diseases (400 beds) 1 Oonvalescent Depots (2,000 men each) 2 Base Depot of Medical Stores 2 Sanitary Sections .. 3

Ambulance Trains .. 4 http://militaryhealth.bmj.com/ In addition,. the mobilization of one auxiliary motor ambulance convoy will be necessary for the service of these lines of com~unication medical units. These units, if mobilized, will furnish a total of 14,800 hospital beds, of which number 1,440 will be beds for officers. . The mobilization of. two convalescent depots (one for each corps) is absolutely necessary for tJ+e relief of congestion in the hospitals, and as places where men who have been some time under treatment may be

hardened before being again sent for duty with their units. Without these on October 2, 2021 by guest. units the hospitals will not be in a position, after the first six weeks of the campaign, to receive the large numbers of wounded to be expected after a general action. It will be observed that no provision has been made for the treatment of ladies of the nursing services when on the sick list. It is proposed to send such cases as paying patients to the nearest civil hospitals' that take in such patients. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H. Ensor 51

It may be objected that my estimate of the hospital accommodation required is excessive, but it must be remembered that no evacuation of sick and wounded out of the country will be possible, and, also, that sick from such lines of communication units as it may be decided . later to mobilize will have to be accommodated in the above-mentioned lines of communication medical units, not to mention wounded and sick prisoners of war. No help need be ~nticipated from the existing civil hospitals in West­ land. Such hospitals will, in all probability, be very short of accommoda­ tion for civilian patients, especially in the large towns, as a result of hostile air raids. It is hoped that some extra hospitaJ beds will be provided by the voluntary aid detachments, but the number will at first be quite small, and it is not my intention to allow any cases, except such as are not likely to be fit for service under six months, to be transferred to such hospitals.

I It is recommended that the eight general hospitals (each of 1,200

beds) and the venereal hospital should be opened as soon as they· have Protected by copyright. been mobilized, and situated as follows :- Nos. 1, 2, 3 and 4 General Hospitals ... Cardiff Area Nos. 5 and 6 General Hospitals Newport area Nos. 7 and 8 General Hospitals· Swansea area Venereal Diseases Hospital ... Aberavon With regard to the general hospitals (each of 600 beds) it is proposed, in view of the fact that 1st and 2nd Corps will concentrate in Radnorshire . and Monmouthshire, to open four of these at the places given below:-

No. 9 General Hospital Abergavenny http://militaryhealth.bmj.com/ No. 10 General Hospital Pontypool No. 11. General Hospital Builth No. 12 General Hospital Llandovery The remaining four general hospitals should remain in reserve, after they have been mobilized, ready to open where required. It is important that the convalescent depots should be opened for the reception of cases as soon as possible, as the· return of sick and wounded rapidly to their units, after they have been cured of their disabilities, will depend very largely on the efficiency of these units. One convalescent on October 2, 2021 by guest. 'depot should be opened at Penarth and the other at Carmarthen. The general hospitals should, in consideration of the time of the year, be accommodated in buildings wherever possible, but it is recognized that this may not be possible in all cases, and that some of them will be obliged to make use of tents. With regard to the remaining lines of communication medical units :- J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

52 A Western Comman:l B.A.M.C. Staff Tour

One sanitary section lines of co'mmunication should be located m each of the following areas;­ Newport. Cardiff. Swansea. One base depot of medical stores should be opened at Cardiff and the other at Swansea. The following summary gives the medical units, with the numbers of officers and other ranks, which will be required for their service. The figures given include attached non-medical personnel of the transport and dental services and of the convalescent depots, but not those of the Chaplains' Department.

DIVISIONAL MEDICAL UNITS. Units No. Officers Other ranks Field Ambulances .. 132 2,532 Sanitary Sections .. 4 112

NON·DIVISIONAL MEDICAL UNITS. Protected by copyright. Field Ambulances. . 2 22 424 Sanitary Sections .. 2 2 46 Casualty Clearing Stations .. 4 32 328 I Motor Ambulance Convoys .. 3 12 534 Advanced Depots of Medical Stores .. 2 2 16 Mobile Hygiene Laboratories 2 4 10 Mobile Bacteriological Laboratories .. 2 4 10

LINES OF COMMUNICATION MEDICAL UNITS. General Hospitals (1,200 beds) 8 256 1,760 General Hospitals (600 beds) 8 160 1,088 Venereal Diseases Hospitals (400 beds) 1 5 .25 Sanitary Sections .. 3 3 84

Convalescent Depots 2 20 188 http://militaryhealth.bmj.com/ Base Depots of Medical Stores 2 4 40 Ambulance Trains.. 4 12 180

Total 62 674 . 7,377 lOne M.A.C. as a reserve under D.M.S., Westlapd Army.

The regimental medical officers who will be required for duty with regimental medical establishments of the divisions and corps troops are­ the following:- Regimental medical establishments of divisional units 76

" corps troops 18 on October 2, 2021 by guest.

Total. 94 The following numbers of ladies of the nursing services will le required for duty with lines of communication medical units ;- With General Hospitals 1,040 With Ambulance Trains 12

Total 1,052 J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

H. EnsoT 53

MEDICAL EQUIPMENT, ETC. The medical equipment of all medical units, and regimental medical establishments of the Army is up to scale and sufficient stocks are held in the medical stores. The existing supply of antitetanic serum is, however, not likely to meet requirements for more than the first two months of war, and arrange­ .I ments have been made to obtain further supplies from abroad. ' It must be remembered that, as the fighting will occur for the most part over 'highly-manured country, every wounded man must be given a prophylactic dose of antitetanic serum.

ORDNANCE EQUI'PMENT. The hospital clothing provided for field ambulances, casualty clearing stations and general hospitals is on the scale given in the Army Form , G. 109S for these units, and is not sufficient so far as the field ambulances i and casualty clearing stations are concerned. Each field ambulance has

only 150 suits of pyjamas and each casualty clearing station 300 suits. Protected by copyright. If mustard gas be made use of by the enemy, it will be absolutely necessary for each case suffering from its effects to be completely undressed, washed in soap and water and clothed in clean pyjamas before he can be evacuated to the lines of communication. This should be done in the main dressing station of divisions, whenever possible; if not done there, it must be carried out in the casualty clearing stations. In consequence the number of pyjamas provided for these above-mentioned units, while ample for the use of ordinary casualties, will not suffice if mustard gas be used by the enemy. It is very strongly recommended that Ordnance be asked to provide http://militaryhealth.bmj.com/ pyjamas for these units on the following scale :­ Field Ambulances 500 Casualty Clearing Stations 2,000 Experience in former wars has proved that each corps must. be in possession of an ample reserve of stretchers. The numbers provided for the field ambulances, given on Army Form G. 109S are hopelessly inade­ quate when casualties on a large scale have to be dealt with. Each corps should have a reserve of, at least, 500 stretchers, and this number will

have to be very largely increased if the fighti~g later becomes that known on October 2, 2021 by guest. as position warfare.

LAUNDRIES, DELOUSING CENTRES. The provision of these is now the duty of the" Q" branch of the staff.

I It is hoped that they will be on an adequate scale, as on them the continued good health of the troops very largely depends. J R Army Med Corps: first published as 10.1136/jramc-47-01-04 on 1 July 1926. Downloaded from

54 A Western Command B.A.M. C. Staff Tour

ApPENDIX. Table showing how the number 7,300 in hospital by the end of the twenty-second day after operations commence, is arrived at. The calculations of Colonel R. S. Hannay, C.M.G." D.S.O., have been used (JOURNAL OF THE ROYAL ARMY MEDICAL CORPS, March, 1924).

Day Admissions Dio;;cllarges Remaining 1 500 Nil 500 2 500 Nil 1,000 3 500 Nil 1,500 4 500 Nil 2,000 5 5CO Nil 2,500 6 500 Nil 3,000 7 500 200 3,300 8 500 ' 200 3,600 9 500 200 3,900 10 500 200 4,200 11 500 200 4,500 12 500 200 4,800 13 500 200 5,100 14 500 200 5,400

15 500 200 5,700 Protected by copyright. 16 500 200 6,000 17 500 200 6,300 18 500 200 6,600 19 500 200 6,900 - 20 500 200 7,200 21 500 450 7,250 22 500 MiD 7,300 (To be continued.) http://militaryhealth.bmj.com/ on October 2, 2021 by guest.

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