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ART. X.-Debate in the House of Commons on Management

of Hospitals in South Africa, June 29, 1900. ACCORDING to the theory which has, perhaps, found most

favour among the learned of recent years, it was a deterioration in the health of the citizens of the Roman Empire which accounted for the ignominious collapse of the greatest civilised organisation that the world has ever seen. If such was the cause that determined the fate of that which all men thought to be invincible and eternal, health is not less the rock upon which is founded the success of an army in the field. For a time, indeed, and under special conditions, neglect of health may not spell ruin: the Americans in Cuba, and the French in Madagascar, fought and won because those campaigns were comparatively of short duration and conducted against a vastly inferior enemy. But it happens too often that, when an epidemic begins among the ranks, divisions dwindle into brigades, brigades into battalions, battalions into companies, and that the sick, by hampering the transport and consuming those so-called comforts which are in reality necessities, spread, as it were, a second contagion throughout the forces and paralyse the whole.

During the ten months which preceded the actual outbreak of hostilities in South Africa, the shadow of war seemed constantly to shift: now it receded beyond the horizon, and now it stood almost overhead. But throughout that period our people were, as the Greeks would have termed it, three removes from any anxiety, or even thought, as to the preparations to be made by the Royal Army Medical Corps for the possible event of war.

Conscious themselves of not desiring it, they did not believe in its outbreak; even should it occur it was sure to be short and sharp, thus affording no scope for extensive sickness; and, thirdly, if both these two anticipations were to be negatived, they had no reason to place other than the most complete confidence in the War Office arrangements.

If such was the feeling of the general public, those who had studied the situation from a more intimate standpoint did not share those sentiments. To begin with, the corps during recent years had suffered a serious decline in numbers while our army had increased, for whereas its total of officers was a little over 850 at the commencement of this year, that figure showed a falling off in two years of not far

from one hundred officers. The cause, or at least a main cause, was the unpopularity of the service among those entering the medical profession, as is instanced by the fact that in the last examination held before the war only fourteen candidates presented themselves for twenty-eight appointments, the remaining vacancies having to be filled by nomination. To put the matter in another light, it is a fact that notwithstanding an increased army the medical establishment of officers immediately before the war was about 20 per cent. under what it was thirty or forty years ago. No further proofs are needed of what, indeed, is a matter of common knowledge among members of the profession, that the corps was not only undermanned, but was being stocked with men of inferior calibre.

Such facts as these gave rise to two remarkable expressions of opinion from authoritative sources previous to the outbreak of hostilities. The British Medical Journal,' having devoted itself to an examination of Lord Wolseley's statement that we had two army corps complete in every

respect,' came to the conclusion that as far as the medical service was concerned the prospect of such a mobilisation was 'alarming,' and indicated a dread of an experience of the Crimean folly.' Professor Ogston, the Regius Professor in Surgery at Aberdeen, in delivering a lecture shortly before the war, referred to the deputation from the British Medical Association which waited on the Secretary of State in 1898, to inform him through its president that if there were to

come a time of war, it is to be dreaded that all the horrors • which occurred during the Crimea may be repeated,' in response to which Lord Lansdowne admitted that only the comparatively inferior men present themselves, and that it was a very grave condition of things. The Professor pointed out that the service is undergoing rapid deterioration,' that the Ministry had recently admitted that the medical contingent for two army corps was not available, and that it was a “fatal error' to imagine that an organisation could be suddenly created by calling in civil aid.

To such administrative anxieties at home was added the knowledge that in South Africa any campaign would be productive of much sickness of the most serious kind. In Lord Wolseley's 'Soldier's Pocket-book,' as published in 1886, it is stated that the ratio among our troops of those constantly non-effective from sickness in South Africa was nearly 50 per 1,000. But, according to the last report of the Army Medical Department in 1898, that figure had risen

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to 561 per 1,000, the cause probably being that the pre

valence of enteric fever in the command is assuming grave 'proportions. Indeed, it was well known that enteric or, in other words, typhoid fever was a common scourge of South Africa, due to the neglect of ordinary sanitary precautions and the consequent absence of a pure water supply. * Extraordinary precautions are urgently needed against

enteric fever' were the warning words used by SurgeonGeneral Jameson, Director-General of the Army Medical Department.

If such was the condition of the department on the one side, and the dangers of disease upon the other, the events which immediately accompanied the actual outbreak of hostilities did not seem reassuring. On the mobilisation of the first Army Corps, Nos. 1, 2, 3, and 4 general hospitals were ordered to accompany it, not to mention four stationary hospitals, twelve field hospitals, and eight bearer companies. It is the business of the Ordnance Department to supply such material as tents, beds, and wagons to the medical service. According to the statement of Sir Henry Brackenbury, Director-General of Ordnance,* 'the reserve of hospital equipment previous to the outbreak of the war was totally inadequate : they had a reserve of only one base hospital of 520 beds, and two stationary hospitals of 110 • beds each. Colonel Steevens, Principal Ordnance Officer, added that on several occasions he asked to be allowed to proceed with the equipment of the necessary base hospitals, but was refused permission, and that, though it required about four months for the whole, he did not receive orders to proceed with the preparations until October 4. What was the explanation of this ? Sir Ralph Knox, Permanent Under-Secretary for War, stated that the Government had not in July, or even in August, made up its mind as to what would have to be done.t Nor were matters much more satisfactory as regards the staff of the Army Medical Corps. Immediately after the outbreak of war the total strength of the officers of the corps was 833, or 60 below the figure which a late director-general had pronounced perilously

low.' It was distributed as follows:- 408 at foreign stations, 245 in South Africa, and 140 at home, besides other details to the number of 40. One single army corps had been mobilised at that date; a second army corps could

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* Daily News, July 25, 1900. † Daily Telegraph, July 25 1900.

hardly require less than 150 officers, and yet, as the British * Medical Journal' stated, “barely 100 medical officers are available to complete the mobilisation of a second army corps should that prove necessary; and not a man will be left at home to fill vacancies. Is this a safe and creditable position for a great and humane country?' Nor was this all. The embodiment of the Militia was proceeding a pace. But, with the exception of a few companies of the Militia Medical Staff Corps trained for bearer duties, the Militia have no medical officers or establishments, but rely on the Royal Army Medical Corps. Against all this the Medical Corps, so far as itself was concerned, had one resource : 98 of its former members were on the retired pay list and liable to be summoned. But in the time of crisis this did not avail much, since of this number some proved unfit, others held permanent military appointments at home, and ultimately only four were sent out to South Africa.

So far, then, as our investigation has proceeded, several facts of the gravest import seem established beyond dispute. We have it on the highest authority that those who enter the Army Medical Corps are not otherwise than of com' paratively inferior' capacity as a rule; that the corps is dangerously undermanned ; that the mobilisation of a single army corps used up its spare officers; that its reserve practically does not exist for purposes of active service; that its reserve equipment was utterly inadequate; and that no steps were taken until October 4 to remedy that deficiency, although war actually began on October 11.

Then occurred a wonderful transformation scenean almost miraculous change---a metamorphosis as satisfactory as any recorded. War was declared, and disorganisation, instead of exhibiting itself, disappeared from view. The curtain fell upon confusion only to rise immediately upon a department working like a machine. Its success was indeed so instantaneous and striking that even its heads and its representatives acknowledged it, for the relief of a public which had never been anxious. The most authoritative of such utterances were those of the Director-General of the Army Medical Service and of Sir William MacCormac. In a speech delivered by the former as early as November he explained that, prior to the outbreak of war, the surgical equipment had been so perfect that only a few extra nailbrushes ' were now required, * while as regards the dreaded

British Medical Journal, November 25, 1899, p. 1488.

enteric he had taken the 'extraordinary precautions' of ordering Berkefeld filters—an order which we believe was not fully carried out—and of allowing anyone to be inoculated who liked. To these two precautions was added a third--the distribution among the Medical Corps of an American pamphlet on sanitation. Sir William MacCormac, who had been sent out at the Director-General's suggestion, in the capacity of a consultant, arrived at Cape Town in November, inspected No. 1 General Hospital, the only one then in working order, since No. 2 was not ready until the closing days of the month, and proceeded at once to Natal. On bis way to Natal he wrote a public letter, declaring that the equipment for the sick and wounded was unprecedented and perfect, though with the exception of the base hospital mentioned the medical arrangements were either hundreds of miles up the railway with Lord Methuen's column, which he had not visited, or in Natal, the principal seat of operations, where he had not yet arrived.

The next authoritative utterances were those of Lord Roberts and General Buller in reply to certain articles which appeared in the Times' of January. Telegraphing towards the close of January, the former general expressed himself “perfectly satisfied with all arrangements, while the latter could only express my admiration' for them; and, accordingly, these preliminary criticisms disappeared. Proceeding in order of time, we may observe that the chorus of congratulation grew stronger as the months advanced. In March it was stated in the House of Commons that the Army Medical Corps was the real success of the war, while an article in Blackwood, evidently written by a person of experience, eulogised in the same month the marvel• lously perfect organisation and the impossibility of detecting the slightest flaw' in the operations of the Medical Service.

But of course the great climax came at the memorable banquet given at the end of April by the Reform Club to Sir William MacCormac and Mr. Treves, when Lord Rosebery presided and spoke with all his accustomed eloquence. He pointed out that, in regard to the war, 'there has been 'unanimity only on one point, and enthusiastic unanimity

that our medical and hospital service has been practically perfect.' Sir William MacCormac and Mr. Treves endorsed Lord Rosebery. They said they had been through the campaign and seen only perfection, though Lord Roberts pointed out subsequently that óneither of these two gentle

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