BURG.-GEN. H. D. ROLLESTON: NAVAL MEDICINE IN THE GREAT WAR. 255 but no female nurses. Two padded rooms are provided for the reception of lunatics. A small ambulance train of six An Address coaches, called 6 1 the shuttle," travels locally between the ON naval bases and the local hospitals. Sir James Porter and Acting Staff-Surgeon A. V. Elder, R.N.V.R., devised a plan NAVAL MEDICINE IN THE GREAT WAR whereby the Service cot, irito which the patient is placed in his own or in the is Delivered at the Medical Society of London ship hospital ship, securely suspended and lashed up the fender at the side of the coach in on Feb. 12th, 1917, against the ambulance train, thus avoiding the fatigue necessitated BY H. D. ROLLESTON, C.B., M.D.CANTAB., by transfer from a stretcher to a fixed cot in the ambulance F.R.C.P. LOND., train. TEMPORARY SURGEON-GENERAL, R.N.; CONSULTANT PHYSICIAN, ROYAL Hospital sltips.--The experience of the present war has NAVY; SENIOR PHYSICIAN, ST. GEORGE’S HOSPITAL. somewhat modified previous conceptions of the uses of hospital ships. In peace-time a hospital ship accompanies the Fleet and MEDICAL PERSONNEL. serves as a mobile base hospital until it becomes full, when she MR, PRESIDENT AND GENTLEMEN,-At the outbreak of leaves the Fleet in order to discharge the patients to a land war the permanent Medical Service of the Navy, with hospital, and for the time acts as a marine medical trans- Sir Arthur May as Medical Director-General, was at once port, or, in other words, a marine ambulance (Elder 1). In expanded by the mobilisation of its retired members, of the South African War (1899-1902), in the transport of officers on the emergency list, and of the medical officers wounded and sick across the Channel, and in the case of of the Royal Naval Volunteer Reserve. In addition, a their service between the Mediterranean and this country at large number of temporary surgeons were entered, and the present time, our hospital ships did, and now, act as about ten consultants were appointed, mainly to the I I M4rine Ambulances"; and in the Russo-Japanese War large base hospitals. A considerable proportion of the (1904-5) the two Japanese naval hospital ships worked on temporary surgeons first passed through the large naval these lines. In modern naval engagements. contrary to hospitals and received some instruction in naval routine what might have been anticipated, the hospital ships cannot and procedure. Rather later an old type of naval medical accompany the Fleet and take charge of the wounded for officer-viz., allied to that of surgeon’s mate-was revived in the following reasons : (1) the hospital ships could not keep the appointment of unqualified medical students who had up with the rapidly moving battleships ; (2) the transfer of passed their examination in anatomy and physiology, under wounded from a battleship to the hospital ship would be the title of Surgeon-Probationers, R.N.V.R. They were possible only in exceptionally calm conditions ; and (3) the usually appointed in batches of 15 to Haslar, where they transfer of wounded would oblige the battleship to h...ave to, were instructed in Service routine, accounts and returns, and thus expose. it to hostile submarine attack. In order victualling of the sick and treatment of wounded in action, to meet this want it has been suggested that fast vessels and were subsequently drafted to destroyers, which ordi- of about 500 tons, registered under the Geneva C mvention. narily do not carry medical officers, and to other small sea- and fitted with appliances for rapidly picking up survivors going ships, to render first-aid. After a certain period of from the sea, should be employed on the scene of a recent service many of them were granted leave to prepare for and action. But this plan has not been put into effect. pass their final examinations, and so to become temporary The use of hospital ships in war-time may, as Elder points out, be divided into: 1. The intervals between actions, surgeons. _ The work of the clinical laboratories of the large base during which the hospital ship remains at the naval base hospitals was assisted by the utilisation of men with until it is full-for four or more weeks-and then discharges laboratory knowledge but without medical qualifications, its patients, by steaming to a railhead, to an ambulance who, however, did not receive naval rank. Dr. P. Fildes train. During its stay at the naval base the load of the hos- was sent to Haslar by the Medical Research Committee and pital ship may be lightened from time to time, and its stay was of the greatest use in dealing with the bacteriological thus prolonged, by evacuation of some patients to a hospital examination- of the numerous convalescents from dysentery, carrisr which conveys them to a land hospital or ambulance enteric ever, and other intestinal diseases sent from Gallipoli. train. A large number of surgical operations are performed Queen Alexandra’s Royal Naval Nursing Service was more in a hospital ship during its stationary period at a naval base than trebled by the mobilisation of the reserve nursing and minor cases when cured return to duty in the Fleet. sisters. The number of nursing sisters at the large base 2. The post-action phase, when the hospital ships are hospitals was thus very largely increased and they were collected at the naval bases to await the arrival of the battle- supplied to the hospital ships, which usually carry four ships, receive the wounded, and serve as clearing stations. nursing sisters, two regulars and two reserves. The existing The wounded and burnt are sorted and as rapidly as possible sick-berth staff, which was considerably depleted when the evacuated to the shore and to the ambulance trains. Severe Fleet was mobilised, was supplemented by the Naval Auxiliary cases, which would obviously suffer from transport, are taken Sick Berth Reserve, composed mainly of men from the to the comparatively small hospitals in the immediate St. John Ambulance Brigade. neighbourhood, but. all suitable cases are at once despatched the ambulance trains to the base in the TRANSPORT OF THE WOUNDED AND SICK. by large -hospitals south of England, so as to clear the land hospitals in the Transport duties are familiar to naval officers, and their vicinity of the naval bases for the reception of further services have naturally been utilised during the war. The instalments of wounded. naval both at home and has been under the transport, abroad, Immediately after a battle, therefore, a hospital oontrol of Sir James ship Surgeon-General Porter, K.C.B., who, ceases to act as a base hospital and becomes a clearing in went out to the early 1915, supervise transport arrange- station, and should be evacuated as rapidly as possible, as ments in for the as well as the Fresh Gallipoli Army Navy. their capacity for cot cases-on an average 250-does not in methods of such as a new developments transport, admit of any extension. It should be added that a hospital ambulance a monowheel stretcher-carrier sling (Boydon), ship may be employed as a permanent floating hospital for (Rev. B. Close), the use of the movable-cot system on infectious diseases at a naval base which is remote from such ambulance and trains, improvements on hospital ships have hospitals on land. been evolved. Hospital ships, like ambulance trains, had to be brought Anabulanee t’1’ains.-Of the four naval ambulance trains in into being when war broke out, and were provided by use at present in this country, the larger ones, made up of 12 the transformation of liners. They were staffed by the coaches and carrying 120 cot cases, travel from the north to existing executive crews of the company and by naval the south as occasion requires, in ordinary times about twice in medical offliers, with a Fleet-Surgeon in charge, and with ten days. Once a week they take the patients off the hospital nursing sisters. ships, and rather less often they collect patients from the naval in the of the naval bases. The 1 Elder. A. V.: On Hospital Ships and Their Functions, Jour. Roy. hospitals vicinity patients Nav. Med. Service, 1916, ii., 443. in 2 are dropped succession at the large naval hospitals, At the Battle of the Yellow Sea on August 10th, 1904, the Russian Plymouth, Haslar, Chatham, and occasionally at Portland. hospital ships followed their Fleet, and, as the Japanese point out, These, colloquially called "round two medical ran the risk of being accidentally torpedoed. (The Surgical and " trains, carry Medical History of the Naval War between Japan and Russia (1904- officers, a crew of 36 stewards and sick-berth attendants, 1905), 1911, pp. 121, 150.) 256 SURG.-GEN. H. D. ROLLESTON: NAVAL MEDICINE IN THE GREAT WAR. THE HEALTH OF THE NAVY. ffor the figures of which I am indebted to Surgeon-General *D. T. G. and In this a distinction Hoskyn, Surgeon-General Welch, Surgeon- considering subject may conveniently General W. H. shows for two be made between the health the shore and Norman, that, allowing peaks of.(i.) depots duer to extraneous causes on there was training establishments ; (ii.) the Service afloat ; and (iii.) (campaigns land), a rise from the beginning of the war until April, the Royal Naval Division and the Marines serving on land. gradual a1916, after which there came a slight fall. This would at I.-The Shore Depôts and Training Establishments.