October i8, 1906] 



NA TURE 



613 



was to be carried out, the total number of surfjeons to 

 be maintained was excessive. Putting aside this ques- 

 tion of economy and distribution of personnel, the 

 system was extravagant owing- to tlie hospitals being- 

 regimental also; this involved an unnecessary dupli- 

 catioi-i of equipment, while, too, in many instances 

 the regimental surgeons, by this limitation of their 

 >pherc of duty, had a tendency to drift into a quasi- 

 routine method of professional practice. 



In 1S5S, following the close of the Crimean War, 

 came the Royal Commission under the presidency of 

 Sidney Herbert. The immediate result of its report 

 u.'is the formation of the .Army Medical School at 

 Nctley for the tr.-iining- of medical officers in military 

 technical duties, also the re-modelling of the service 

 and the initiation of practical reforms in the adminis- 

 tration of military medical affairs, as well as the crea- 

 liiin for hospital duties of the .Army Hospital Corps, a 

 body of men possessing a corfiplete military organisa- 

 tion. In 1873 the system of regimental surgeons, 

 except in the Guards, was abolished finally, and all 

 medical officers were consolidated into o[ie staff; at the 

 same time disappeared also the regimental hospitals, 

 their places being taken by general hospitals and 

 station or field hospitals. From this date all regi- 

 mental organisation ceased to exist, the arrangements 

 for medical affairs passing into the hands of the 

 medical officers alone. In 1S77 authority was given to 

 medical officers to command the whole of the .Army 

 Hospital Corps, and also all patients in military hos- 

 pitals, as well as other soldiers attached to them for 

 hospital duty. From this date the medical officers be- 

 came invested with the responsibilities as to discipline, 

 training, supply, payment, and movement of their own 

 subordinates, similar to the responsibilities resting 

 upon a commissioned officer in any other branch of 

 the service. In 188,^ the appellation of the Army 

 Hospital Corps was changed to Medical Staff Corps, 

 and in i8q8 the Medical Staff and the Medical Staff 

 Corps were further consolidated into an autonomous 

 whole as the Royal Army Medical Corps of the present 

 time. .As a necessary sequel to the functions and 

 responsibilities of the Corps in its new organisation, its 

 officers were given full army rank and title, thus 

 completing the evolution of the medical service from 

 the chaotic state when its personnel were mere camp 

 followers endowed with neither official status nor re- 

 sponsibility to the completely autonomous and purely 

 military organisation of to-day. These recent reforms 

 have embraced the granting of good pay, liberal terms 

 of service and study, with the abolition of the archaic 

 school of instruction at Nctlev and the substitution 

 of a Royal .Army Medical College in London, where 

 the officers of the Corps are brought into intimate 

 touch with the newest theories and practice of medi- 

 cine. In a word, the liberal and far-seeing policy of 

 those responsible for the reforms of iSqg to 1902 has 

 revolutionised the position and moral of the Corps, 

 with the result that its 1002 officers and 4189 non- 

 commissioned officers and men constitute a contented 

 and thoroughly efficient body of technically trained 

 men, equipped and able to meet the needs of the sick 

 and the wounded. 



Is the task ended? it may be asked, and have we 

 reached finality in our efforts to build up a medical 

 corps at once worthy of the country and the .Army of 

 which it is an integral unit? Unfortunately no; there 

 is much yet to be done. Military history has. up to 

 to-day, been a history of the b.ittle only, of brave 

 deeds done and suffering bravely borne ; but what of 

 the history of the means by which armies were 

 rendered numerically efficient and placed in a con- 

 dition to fight? We have faced the nroblem of how 

 to treat and provide for the sick and wounded, and 

 NO. 1929, VOL. 74] 



unhesitatingly compel our commanders to encumber 

 their fighting force with impedinienla and medical 

 provision for 10 per cent, of sick; but need this be? 

 The two great scourges of armies in the field are 

 enteric and dysentery. During the late war in South 

 -Africa, these two diseases alone caused 74,000 

 admissions to hospital and 9200 deaths. Yet both 

 diseases are largely preventable. It is no exagger- 

 ation to say that for every man wounded in war 

 twenty sick men are brought to hospital, largely from 

 preventable causes. The unopposed crossing of the 

 Modder River lost us more men froni enteric than the 

 battle of Colenso lost us from wounds. Surely if this 

 enormous waste of fighting strength is avoidable, the 

 prevention of sickness and disease in a field force is 

 of more importance than the mere treatment of its 

 victims. Thanks to the evolution in its organisation 

 and perfection of equipment which the Royal .\rmy 

 Medical Corps now presents, the soldier of to-day has 

 a better chance of recovery than the sick or vi-ounded 

 man of the Peninsular or Crimean Wars ; but the 

 same cannot be said of the soldier's chances of con- 

 tracting preventable disease, for the organisation and 

 equipment of the British .Army as to disease prevention 

 remain little better than they were a hundred years 

 ago. The reason of this is, that army administration 

 (medical) has not kept pace with the advance of 

 science, and has neglected to note early the influence 

 of Pasteur's work upon the problem of war. This, 

 then, is the task still before the army medical service — 

 how to translate scientific knowledge into an adminis- 

 trative system for the efficient prevention of disease 

 among troops in the field. This would be easy 

 enough if no regard were paid to the necessities of 

 mobility and supplies, but those are points which we 

 cannot ignore ; in fact, the whole object and aim of 

 sanitary effort is to increase fighting efficiency and 

 lessen transport ; therefore, in our campaign to re- 

 duce the incidence of preventable disease, we need to 

 be careful not to add impedimenta to the Army -with 

 one hand even though we take some away with the 

 other. 



It is to the solution of this problem that the medical 

 corps of the .Army is now devoting itself, and the 

 principles on w-hich it is working are briefly these : — 

 (i) the .Army at large, from highest to lowest, must 

 be educated to appreciate the need of radical re- 

 forms in the direction of preventing disease, and to 

 understand that these cannot be secured " by order " 

 only, but require personal effort on the part of each 

 individual and the recognition by officers of their own 

 direct responsibility for the health of their men ; 

 (2) the elaboration of an organised system for pro- 

 viding safe and potable water for all troops when in 

 camp or on field service. The practical application of 

 the first principle has taken the form of systematic 

 instruction in the various garrisons of all ranks in 

 elementary sanitation. These classes are conducted by 

 officers of the Royal .Army Medical Corps, whereby 

 the importance of personal effort on the part of both 

 officers and men is enforced and the special training 

 of a certain number of men in practical sanitation 

 secured, so that each unit may have its own sanitary 

 squad for these special duties. Having these trained 

 men at their disposal, it is hoped that commanding 

 officers will find no future difficulty in the mainten- 

 ance of their own lines and camps in conditions of 

 sanitary efficiency. For the provision of safe and 

 approved water to each unit in the field the Royal 

 .Armv Medical Corps proposes to take full responsi- 

 bility, and to this end every water-cart, every filter, 

 every heat steriliser, and all chemical reagents for the 

 routine purification of water will be in the charge 

 of, and worked by, trained men of the Medical Corps. 



