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\ci^\ history 




HISTORY OF THE GREAT WAR 

BASED ON OFFICIAL DOCUMENTS 



MEDICAL SERVICES 
GENERAL HISTORY 



VOL. I 

MEDICAL SERVICES IN THE UNITED KINGDOM ; 

IN BRITISH GARRISONS OVERSEAS ; AND DURING 

OPERATIONS AGAINST TSINGTAU, IN TOGOLAND, 

THE CAMEROONS, AND SOUTH-WEST AFRICA 



BY 



MAJOR-GENERAL SIR W. G. MACPHERSON 

K.C.M.G., C.B., LL.D 




LONDON: 

PRINTED AND PUBLISHED BY 

HIS MAJESTY'S STATIONERY OFFICE 
1921 




LONDON : 

PRINTED AND PUBLISHED BY 

HIS MAJESTY'S STATIONERY OFFICE. 

To be purchased through any Bookseller or directly from 
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or from EASON & SON, LTD., 40-41, LOWER SACKVILLE STREET, DUBLIN. 

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Price l\ Is. Od. Net. 



CONTENTS 

PAGE 

List of Maps, Charts, etc. . . . . . . . . v 

List of Abbreviations . . . . . . . . . vi 

Preface vii 

CHAPTER 

I. Preparation of the Army Medical Service for War. 

Organization . . . . . . . . . . . . 1 

II. Preparation of the Army Medical Service for War 

cont. Personnel and Training . . . . . . 20 

III. Mobilization of the Medical Services . . . . . . 42 

IV. Administration of the Medical Services . . . . . . 58 

V. Hospital Accommodation in the United Kingdom . . 71 

VI. The Reception, Distribution and Disposal of Sick and 

Wounded in the United Kingdom . . . . . .. 96 

VII. The Medical Examination of Recruits .. .. .. 118 

VIII. The Recruiting and Training of Personnel for the 

Medical Services . . . . . . . . . . 138 

IX. The Supply of Medical and Surgical Equipment and 

Stores lap 



X. Sanitary Organization in the United Kingdom . . 190 

XI. Organization of Voluntary Aid . . . . . . ' . . 208 

XII. Demobilization 223 

XIII. The Medical Services in the Mediterranean Garrisons.. 235 

XIV. The Medical Services in Bermuda, Jamaica, and 

Mauritius 252 

XV. The Medical Services in Hong Kong, Straits Settlements , 

and Ceylon . . . . . . . . . . . . 257 

XVI. The Medical Services during the Operations against 

Tsingtau 268 

XVII. The Medical Services in West Africa and during 

Operations in Togoland . . . . . . . . 277 

XVIII. The Medical Services during the Operations in the 
. Cameroons 

XIX. The Medical Services in South Africa 

iii 
(1735) Wt. 25789/476 1/21 1500 Harrow G.51 



iv CONTENTS 

PAGE 
CHAPTER 

XX. The Medical Services during the Operations in South- 

West Africa 323 

XXI. The Medical Services during the Operations in South- 

West Africa cont. 339 

Appendix A. The Medical Units of the Expeditionary Force 

mobilized in August, 1914 . . . . . . 357 

B. Military Hospital Ships and Ambulance 

Transports . . . . . . . . . . 365 

C. Hospital Ships destroyed by Submarines or Mines 369 

D. Tables of Sick and Wounded arriving in the 
United Kingdom from Expeditionary Forces 
and Garrisons Overseas . . . . . . 37 1 

E. Tables of Medical and Surgical Equipment and 
Supplies 

,, F. Tables connected with the Operations in the 

Cameroons .. .. .. .. . . 419 

G. Tables connected with the Campaign in South- 
West Africa 431 

Index .. .. 441 



LIST OF MAPS, CHARTS, ETC. 



TO FACE 
PAGE 



Table of War Organization for Administrative Medical Services 
in the United Kingdom under the control of D.G.A.M.S. 
at the War Office at the time of the Armistice and after . . 

Table of War Organization of Administrative Medical Services 
in a Command at Home 

Chart showing the Number of Beds Equipped and Vacant and 
the Number of Patients in Hospital in the United Kingdom 
from August, 1914, to December, 1919 

Medical Embarkation Staff as constituted for Home Service 

Table showing Distribution and Disposal of Sick and Wounded 
arriving from an Expeditionary Force 

Plans of Accommodation for a Recruiting and Pensions Board 

Chart of Movement of R.A.M.C. Recruits previous to being 
drafted as Reinforcements for Theatres of War 

the R.A.M.C. Reserve Training Centre, 



65 

67 

94 
101 

117 
132 

157 
159 
236 



Organization of 
Blackpool 

Map of Malta, showing Distribution of Hospitals and Con- 
valescent Camps 

Chart showing Monthly State of Beds Equipped and Occupied 

in Malta 248 

Map of Area of Operations against Tsingtau . . . . . . 268 

Map of German Protectorate of Tsingtau . . . . . . 270 

Map of Operations against Togoland . . . . . . . . 280 

Map of Duala and Cameroon Estuary . . . . . . . . 282 

Map of the Cameroons . . . . . . . . . . . . 290 

Photographs of the Cameroons . . . . . . . . . . 284-307 

Map of German South- West Africa . . . . . . . . 324 

Chart of Sick-rates in the South- West African Campaign . . 352 

Chart of Incidence of Enteric Fever, South-West Africa . . 353 
Photographs of the South- West African Campaign .. ..328-351 



ABBREVIATIONS IN VOLUME I 

A.C.I. . . . . Army Council Instruction. 

A.D.G. . . . . Assistant Director-General. 

A.D.M.S. . . . . Assistant Director of Medical Services. 

A.G. . . . . Adjutant-General. 

A.M.S. . . . . Army Medical Service. 

A.M.S. (R.P.) .. Army Medical Service (Retired Pay). 

B.R.C.S British Red Cross Society. 

C.C.S. .. .. Casualty Clearing Station. 

D.A.D.M S. . . . . Deputy Assistant Director of Medical Services. 

D.A.D.G., A.M.S. . . Deputy Assistant Director-General, Army Medical 

Service. 

D.D.G., A.M.S. . . Deputy Director-General, Army Medical Service. 

D.D.M.S. . . , . Deputy Director of Medical Services. 

D.G., A.M.S. . . Director-General, Army Medical Service. 

D.M.S. . . . . Director of Medical Services. 

G.H.Q. . . . . General Headquarters. 

G.O.C. . . . . General Officer Commanding. 

I. M.S. . . . . Indian Medical Service. 

L.C.C. . . . . London County Council. 

L.G.B. . . . . Local Government Board. 

L. of C. . . . . Lines of Communication. 

M.B. . . . . Mounted Brigade. 

M.B.F.A Mounted Brigade Field Ambulance. 

M.O. .. .. Medical Officer. 

M.O.H Medical Officer of Health. 

O.R. . . . . Other Ranks. 

P/W. . . . . Prisoners of War. 

Q.A.I.M.N.S. . . Queen Alexandra's Imperial Military Nursing Service. 

Q.M.A.A.C. .' . Queen Mary's Auxiliary Army Corps. 

Q.M.G. . . . . Quartermaster-General. 

R.A.M.C. . . . . Royal Army Medical Corps. 

S.A.M.C. '. . . . South African Medical Corps. 

S.A.M.N.S. . . . . South African Military Nursing Service. 

S.A.M.R South African Mounted Rifles. 

S.M.O Senior Medical Officer. 

S.R. , . . . . Special Reserve. 

S.V.M.C. . . . . Singapore Volunteer Medical Corps. 

S.W.A South- West Africa. 

T.F. . . . . Territorial Force. 

T.F.N.S Territorial Force Nursing Service. 

V.A.D. . . . . Voluntary Aid Detachment. 

V.A.D. (G.S.) . . Voluntary Aid Detachment (General Service). 

W.A.A.C. . . . . Women's Army Auxiliary Corps. 

W.A.F.F. West African Frontier Force. 



PREFACE 

IT has always been a matter of regret amongst students 
of the medical histories of wars that a consecutive 
history relating to the medical services has rarely been 
compiled, at any rate in connection with British campaigns. 
The facts and lessons taught by war have to be searched for 
in reports of Royal Commissions and of parliamentary, inter- 
departmental, and War Office committees ; in the appendices 
to the annual reports of the Army Medical Department ; in 
general publications and articles in journals ; in Continental 
literature ; as well as amongst other documents, many of 
which are untabulated and their existence not generally 
known. Popular books which deal mainly with details of 
interest to the general reader and are usually published 
before all the facts are available must necessarily be of 
limited historical value, and, although they throw many 
sidelights on events, frequently fail in accuracy and are 
consequently apt to be misleading. Thus the opportunities 
for studying the organization, development, and work of 
the medical services in the different phases of a campaign, 
and the details of the diseases, wounds, measures for the 
prevention of inefficiency, and other matters of medical and 
national interest are not readily available although they may 
have been recorded in official documents. 

The main object, therefore, in preparing a consecutive 
medical history of the great war is to present in an accessible 
form the material buried in masses of war diaries, adminis- 
trative files, official reports and other documents before they 
have been stored away and their existence forgotten except 
by a few. The feature which stands out most prominently in 
the history of the medical services is the magnificent and 
harmonious co-operation afforded by the medical profession 
throughout the Empire, and by a host of voluntary and 
other helpers in the work of the Army Medical Service 
and the Royal Army Medical Corps. A history of the 
medical work in the war becomes, therefore, a record not 
only of the medical services of the regular army but of 
all those who worked in it and with it. Probably no 
other branch of the army had such a widely distributed 
civil reserve from which to supplement its ranks in the 
national emergency ; and it is significant that the general 

vii 



viii MEDICAL HISTORY OF THE WAR 

desire in the medical world for a medical history of the war 
in accessible form was first brought to notice by Professor 
Adami, the Professor of Pathology and Bacteriology in the 
McGill University, Montreal, in a letter dated the 25th 
September, 1914, to Sir William Osier, the Regius Professor 
of Medicine at Oxford University. Professor Adami, who 
afterwards himself took part in the war in the rank of 
colonel in the Canadian Army Medical Corps, pointed out 
in his letter that in none of its wars had Great Britain 
thoroughly worked up its medical history. He suggested 
the formation of a committee with assistants in each base 
hospital to take charge of all case sheets, to secure fuller 
details of cases which promised to be of special importance, 
to preserve materials for a museum, and to make the 
necessary preparations for obtaining full records for a medical 
and surgical history of the war. 

His letter was forwarded by Sir William Osier to the 
Director-General of the Army Medical Service, and on the 1 1th 
November, 1914, Surg.-General Sir Alfred Keogh, who had then 
been re-appointed to act as Director-General at the War Office, 
selected Lieut. -Colonel, then Captain, F. S. Brereton, an officer 
who had retired from the Royal Army Medical Corps and had 
subsequently devoted himself to literary work, to undertake 
the duty of preparing material for a medical history of the 
war. Lieut. -Colonel Brereton had accepted a temporary 
commission in the Royal Army Medical Corps when war broke 
out and was employed at the time as deputy assistant 
director of medical services in the Eastern Command. He 
was provided with an office and given authority to form a 
clerical establishment. The war diaries of medical units and 
administrative medical officers were sent to this office. With 
the arrival of a constantly increasing number of war diaries 
more accommodation became necessary and the office was 
moved to Brook House, Francis Street, Tottenham Court Road. 
As there were comparatively few documents in the first months 
of the war, Lieut. -Colonel Brereton's staff consisted of one 
lady clerk until May, 1915, when it was increased to two, 
and in September of the same year to five. There was no 
further increase until April, 1918, when two R.A.M.C. clerks 
and six lady clerks formed the staff. 

But shortly after these arrangements for collecting 
material for a medical history of the war had been made, 
Sir Walter M. Fletcher, then Dr. W. M. Fletcher, the Secretary 
of the Medical Research Committee of the National Health 
Insurance, proposed that the services of his committee should 
be placed at the disposal of the Army Medical Service to assist 



PREFACE ix 

in the preparation of the medical statistics of the war. This 
valuable offer was promptly accepted and Sir W. Fletcher 
proceeded to organize a statistical department under the 
charge of Dr. J. Brownlee, the statistician of the Medical 
Research Committee. Premises were secured in Guilford 
Street, then in the British Museum, and finally in Endell 
Street. All the statistical records and medical case sheets 
both from military hospitals at home and from medical units 
and hospitals overseas were collected there for arrangement 
and scientific analysis under the general management of 
Mr. M. J. C. Meiklejohn. Dr. M. Young with a large staff 
of clerks was then appointed for abstracting, coding and 
tabulating the statistics of wounds and diseases. An un- 
official attempt had already been made by Dr. W. N. Barron 
who was afterwards given a temporary commission as 
Lieut. -Colonel in the R.A.M.C., with the assistance of some 
voluntary workers to compile medical statistics in Paris, but 
it was obvious that these voluntary efforts could not attain 
efficiency, and Dr. Barren's work was abandoned when the 
Medical Research Committee undertook the work. 

Sir Alfred Keogh also appointed a consultative committee 
to study the subjects of which a medical history of the war 
should consist. It met for the first time under his presidency 
on the 9th March, 1915, when the following sub-committees 
were formed : 

Statistics . . . . Dr. J. Brownlee. 

Lieut-Colonel H. P. W. Barrow. 

Lieut. -Colonel W. N. Barron. 
Medicine . . . . Sir William Osier. 

Lieut. -Colonel O. L. Robinson. 
Surgery . . . . Lieut. -Colonel E. M. Pilcher. 

Professor F. F. Burghard 
Sanitation . . Colonel W. H. Horrocks. 

Lieut.-Colonel W. W. O. Beverridge. 
Bacteriology and Colonel Sir W. Leishman. 
Pathology. Captain F. W. Andrew es. 

Sir Walter Fletcher and Lieut.-Colonel Brereton were 
appointed joint secretaries, the former for all matters 
connected with the technical, professional and scientific 
subjects, and the latter for the general history. 

Although this committee did not meet at any subsequent 
period after its first and only meeting in March, 1915, both 
Sir W. Fletcher and Lieut.-Colonel Brereton continued to 
collect and organize material for a medical history. The 



x MEDICAL HISTORY OF THE WAR 

Medical Research Committee placed its organization for 
professional and scientific investigation at the disposal of the 
War Office and devoted much of its time and resources during 
the war to the collection of material for the medical, surgical, 
pathological,and statistical sections. It initiated investigations 
into several problems connected with the injuries and diseases 
of the war and published several monographs from time to 
time on these subjects. Pathological specimens of diseases 
and injuries were collected, and the museum staff of the 
Royal College of Surgeons undertook the task of arranging, 
preserving and classifying them. Professor Arthur Keith, 
the conservator of the Museum, Sir John Bland Sutton, and 
Professor C. E. Shattock specially interested themselves in this 
work, and a unique and valuable collection of specimens of 
war injuries and diseases, including casts, drawings and 
paintings from all theatres of war and home hospitals are now 
available for study in the Museum of the Royal College of 
Surgeons pending the provision of an Army Medical War 
Museum. Lieut.-Colonel T. R. Elliott was mainly responsible, 
as representative of the Medical Research Committee in 
France, not only for perfecting the system by which 
pathological specimens were collected in France and for- 
warded to the museum, but also for instituting an improved 
system of field medical cards and case cards which should 
include valuable statistical information regarding diseases and 
wounds. Two official artists were also employed in France 
under Lieut.-Colonel Elliott's instructions. Mr. S. A. Sewell 
worked under a contract with the Medical Research Com- 
mittee at Boulogne from December, 1915, but subsequently 
Mr. A. K. Maxwell was enlisted in the R.A.M.C. and went to 
Boulogne in August, 1916, with a view to making coloured and 
other sketches of cases in hospital and of pathological speci- 
mens. The value to the nation at large of the scientific work 
thus initiated and carried out cannot well be over-estimated. 
In connection with the general history, Lieut.-Colonel 
Brereton was authorized to visit the different battle fronts 
and collect sketches, plans and photographs for the formation 
of a museum which would contain illustrations and models 
of the character and work of the medical services from front 
to base, including sanitary appliances and other objects of 
historical interest. This valuable collection is now temporarily 
housed in the medical section of the Imperial War Museum, to 
the committee of which Lieut.-Colonel Brereton was appointed 
as representative of the Army Medical Service in November, 
1917. The work connected with the collection and preparation 
of this museum developed rapidly and led in November, 1918, 



PREFACE xi 

to the sanction of a fixed war establishment for the office of 
the committee for the Medical History of the War and Army 
Medical War Museum, with Lieut. -Colonel Brereton as officer 
in charge. Nine R.A.M.C. non-commissioned officers and men 
who in civil life were artists and sculptors were obtained from 
the R.A.M.C. depot at Blackpool and taken on the strength 
of this establishment. 

The foundations of a medical history were thus laid from an 
early period during the progress of the war, but until the end 
of 1918 no definite steps had been taken for the actual writing 
and preparation of the volumes. For this purpose a new com- 
mittee was formed after a conference at Adastral House on the 
12th December, 1918, under the presidency of the Director- 
General, Lieut. -General Sir John Goodwin. Major-General 
Sir W. G. Macpherson was then appointed Editor-in-Chief and 
given the task of organizing the writing of the history, assisted 
by a committee, which was in constitution similar to the 
original committee appointed by Sir Alfred Keogh in March, 
1915. It consisted of the following, under the chairmanship 
of the Editor-in-Chief : 

Medicine . . Sir William Osier. 

Major-General Sir Wilmot Herringham. 

Colonel T. R. Elliott. 
Surgery .. Major-General Sir Anthony, Bowlby. 

Major-General Sir Cuthbert Wallace. 

Colonel Sir T. Crisp English. 
Hygiene . . Colonel Sir W. H. Horrocks. 

Colonel W. W. O. Beveridge. 
Pathology . . Major-General Sir William Leishman. 

Colonel S. L. Cummins. 
Statistics . . Dr. J. Brownlee. 

Major W. R. Galwey. 

Sir Walter Fletcher and Lieut. -Colonel Brereton were also 
members of the committee for general scientific and historical 
subjects. Sir William Osier had only been able to attend 
one meeting of the committee before his lamented death in 
December, 1919. His place was taken in June, 1920, by 
Lieut. -Colonel Andrew Balfour. 

During the spring and summer of 1919, pending Treasury 
sanction for the preparation and publication of volumes, 
the collection of documents and museum specimens was 
continued, and the committee formed into an editorial 
committee with the members as editors of the subjects which 
they represented. The selection of writers on the professional 
and scientific subjects was considered by them and estimates 



xii MEDICAL HISTORY OF THE WAR 

of cost prepared and submitted to the Treasury. Treasury 
sanction was accorded in August, 1919. Suitable premises 
were obtained in Stanhope House, Kean Street, Drury Lane, 
and the war diaries and other documents collected and arranged 
there under the supervision of the Editor-in-Chief from 
October onwards, with the assistance of Major T. J. Mitchell, 
R.A.M.C., who was appointed to his staff in January, 1920. 

The work of the Army Medical War Museum was then 
separated from that of the Medical History of the War and 
was carried out by Lieut. -Colonel Brereton, who was, 
however, retained on the committee of the latter until 
November, 1920, when he resigned on account of pressure of 
other work. Both Lieut. -Colonel Brereton and Major-General 
Sir W. G. Macpherson were appointed to the Historical sub- 
committee of the Committee of Imperial Defence. They were 
thus in touch with the general principles guiding the 
preparation of official histories of the war and obtained 
valuable assistance from Bdr.-General J. E. Edmonds, the 
director of the military branch of the historical section, and 
his staff. 

More than 38,000 war diaries, in addition to numerous 
reports from commands at home and overseas as well as 
voluminous administrative medical files from the theatres 
of war, were registered and filed in the new office, and the 
various subjects and the documents containing references to 
them were indexed in order to facilitate the writing of the 
history from the available material. 

As the time for the preparation of the history and its 
scope had to be limited to meet the Treasury conditions, the 
following volumes only are being prepared for publication. 
They cover the general functions of the medical services 
in war *: 

General History of the Medical Services Four volumes. 
The Diseases of the War and the Medical 

Aspects of Aviation and Gas Warfare Two volumes. 

The Surgery of the War . . . . Two volumes. 

The Hygiene of the War . . . . Two volumes. 

Pathology and Medical Research during 

the War . . . . . . . . One volume. 

TheMedical Statistics and Epidemiology 

of the War . . . . . . . . One volume. 

* The general functions of the medical service, as definitely laid down 
in Field Service Regulations, are " the preservation of the health of the 
troops ; the professional treatment and care of the sick and wounded ; the 
replenishing of medical and surgical equipment ; and the collection and 
evacuation of sick and wounded from the theatres of operations." 



PREFACE xiii 

The volumes of the general history are a record, as far as 
possible in narrative form, of the chief features of the medical 
services in the United Kingdom, in garrisons overseas and 
with the expeditionary forces in the various theatres of war 
during the years 1914-1918 and during any subsequent period 
in which war incidents of historical interest or importance 
occurred. 

The present volume, the first of the series, deals with 
the medical services in the United Kingdom and in garrisons 
overseas, with an account of the medical services in the 
operations against the German colonies in West and South- 
West Africa and in Tsingtau. The remaining volumes of 
the general history will deal with the medical services in 
France and Italy, in the Mediterranean theatres of war, 
and in Mesopotamia, Aden, East Africa, and Russia. 

With regard to the subjects dealt with in the present 
volume the United Kingdom may be described as the centre 
from which men and material for the medical services were 
sent out to the various theatres of war, and to which a large 
proportion of the sick and wounded were returned for treat- 
ment and final disposal. In a minor degree the same may 
be said of the operations based on overseas garrisons. 

Including labour units provision had to be made at one 
time or another for the medical services of forces with a total 
strength of nearly 3,500,000, operating in every variety of 
country and climate. A total maximum of 637,746 hospital 
beds were equipped and maintained in the United Kingdom 
and in theatres of war. Approximately 770 medical units of 
all descriptions were mobilized in the United Kingdom and 
despatched to expeditionary forces. In addition, 75 hospital 
ships or ambulance transports were equipped and administered 
by medical services in the United Kingdom, and 2,655,025 
sick and wounded were brought to its shores for further treat- 
ment and disposal between August, 1914, and August, 1920. 
The personnel for medical services numbered at the time 
of the Armistice 144,514 officers and other ranks, most of 
whom joined the R.A.M.C. and were trained in the United 
Kingdom. Vast quantities of medical and surgical stores and 
equipment were procured, packed, and despatched. The 
medical services in the United Kingdom were thus a pre- 
dominant and essential factor in the work of the war. 

The material for the present volume has been obtained 
from War Office files, the reports of parliamentary and other 
committees, reports from the administrative medical services 
of commands, from consulting surgeons, physicians, and other 
specialists, from the different branches of the medical 



xiv MEDICAL HISTORY OF THE WAR 

department in the War Office, and from other sources. Valuable 
accounts containing elaborate and full details of the work in 
some of the commands in the United Kingdom have been 
received, but it has been impossible owing to limitation of space 
to reproduce them in full. Many of the large territorial force 
general hospitals and new military hospitals also submitted 
detailed historical accounts of their units, several printed in 
pamphlet form and illustrated. All these contain much of 
general but more especially of local interest, and although 
they might have found a place in the history of the medical 
services in the United Kingdom the details of each of the 
important hospitals alone would fill many pages. It has, there- 
fore, been impossible to publish them in the present volume. 

The information regarding the medical services of the 
Dominions is incomplete, as details have not been received 
from all of their medical services beyond what is contained 
in the war diaries of the medical units in the field. References 
to their work are, therefore, omitted from the present volume, 
but will be found in the volumes on the medical services 
with the expeditionary forces in France and other theatres 
of war. 

The chapter on the reception and distribution of sick and 
wounded is compiled mainly from a report by Major-General 
Sir William Donovan, who was D.M.S. for Embarkation. 

Much information regarding the medical examination of 
recruits has been obtained from the report of the committee 
of the House of Commons appointed to enquire into the 
working of the Military Service (Review of Exceptions) Act, 
1917, from Army Council Instructions and from official docu- 
ments published by the Ministry of National Service, whose 
Chief Commissioner of Medical Services, Sir James Galloway, 
has rendered material assistance. 

The chapter on the supply of medical and surgical equip- 
ment and stores is compiled from very full reports by Major- 
General Sir G. B. Stanistreet and Colonel J. R. McMunn, who 
were in charge of this branch of the medical services at the 
War Office, the former until March, 1918, and the latter from 
that date onwards. The immense extent and variety of equip- 
ment and stores for which they were responsible are indicated 
in Appendix E of the present volume, although many additional 
tables, owing to lack of space, have necessarily been omitted. 

The garrisons overseas in which Royal Army Medical Corps 
personnel were serving at the time war was declared, 
excluding India and Aden, which was under the Indian 
Government, were Bermuda and Jamaica in the West Indies ; 
Sierra Leone in West Africa ; Malta and Gibraltar in the 



PREFACE xv 

Mediterranean ; Ceylon, the Straits Settlements, Hong Kong, 
and North China in the Far East ; Mauritius, South Africa, 
and Egypt. 

Egypt was the base for the operations in Gallipoli and 
Palestine and, consequently, the history of its medical service 
is included in the history of the medical services in these 
theatres of war. But Malta and Gibraltar, especially the 
former, acted in regard to the Mediterranean campaigns in 
much the same way as the United Kingdom did in connection 
with the operations in France. 

South Africa was utilized in a similar capacity for the reception 
of sick and wounded from the East African theatre of war, 
Cape Town being also the base for the campaign against German 
South-West Africa. The expeditions against German West 
African colonies were based to a certain extent on Sierra Leone. 

From all these garrisons accounts have been received of 
the expansion of their medical services to meet the conditions 
which arose from a state of war. The chapters concerning 
them are compiled from these reports. 

The account of the medical services in Togoland is compiled 
from reports by medical officers who took part in the expedition ; 
and that of the operations in the Cameroons from very full 
details and reports by Colonel J. C. B. Statham. Colonel 
P. G. Stock, who was director of medical services during the 
operations in German South-West Africa, compiled the narrative 
on which the chapters dealing with the history of the medical 
services during that campaign is based. But as the official 
account of the military operations was not available at the 
time there may be discrepancies in certain particulars between 
it and the narrative in Chapter XX. These are not, however, 
likely to "be of vital importance for the purpose of the History 
of the Medical Services. The plates of six of the photographs 
have been kindly lent by Mr. Leo Weinthall, the Editor of 
The African World. 

The story of medical services in the short campaign with 
the Japanese against Tsingtau is compiled from a report by 
Colonel J. A. Hartigan, who was senior medical officer with 
the British contingent, but certain details of the operations 
have been obtained from other accounts. In all cases the 
official despatches by the Commanders-in-Chief of the various 
expeditionary forces have been consulted. 

Throughout the volumes the ranks and titles of officers 
mentioned in the narrative are those held by them at the 
time and not those which they may have subsequently 
obtained. 

W. G. M. 



CHAPTER I 

THE PREPARATION OF THE ARMY MEDICAL SERVICE FOR WAR 

ORGANIZATION. 

FOR a great number of years the Army Medical Service 
had little or no experience of wars in Europe or against 
highly trained and organized Continental armies, although 
it had constant experience of wars elsewhere and under 
different conditions. The South African War and the 
experiences of the Russo-Japanese War, however, made it 
necessary to review its organization and capacity for dealing 
with large numbers of battle casualties. Its preparation 
for war in Europe may be said to have commenced then. At 
the time of the South African War it was weak in numbers, 
was barely sufficient for peace requirements, and possessed 
no organization for expansion in war. The establishment 
of officers was designed to provide for the bearer companies 
and field hospitals of two army corps and a cavalry division 
and for seven stationary and three general hospitals on the 
lines of communication. This hospital accommodation pro- 
vided beds for less than 3 per cent, of the troops. The 
establishment of other ranks of the Royal Army Medical 
Corps was designed for peace purposes only. A state of war 
was to be met by civilian assistance, increased employment of 
women nurses, and active recruiting. When the expeditionary 
force went to South Africa the establishments of the bearer 
companies and field hospitals of the 2nd Corps had to be used 
in order to complete the personnel of the stationary and 
general hospitals which accompanied the 1st Corps ; and, when 
provision had been made for the field army, the home hospitals 
were entirely denuded of personnel. The work in them was 
carried on by retired officers and civil surgeons.* 

Had this been the state of their readiness for war in 1914, 
the medical services could scarcely have weathered the storm 
of public criticism which would have arisen after the first 
shock of battle, and after wounded, with their tales of hard- 
ship and suffering, possibly of neglect, had begun to flow into 

* See the Official " History of the South African War," Vol. 1, p. 25, 
and the Report of the Royal Commission appointed in 1903 under the 
Chairmanship of Lord Elgin to enquire into the military preparations and 
other matters connected with the war in South Africa. 

(1735) 1 . B 



2 MEDICAL HISTORY OF THE WAR 

the hospitals in the United Kingdom, as would inevitably 
have been the case, in numbers beyond all previous 
anticipation and experience. When one scans the volumes 
of reports of Royal Commissions, of parliamentary and other 
enquiries, with their masses of printed evidence, to which 
breakdowns in the arrangements for the care of the sick and 
wounded in previous wars gave birth, a prominent contrast is 
afforded by the singular freedom of the Army Medical Service 
from adverse criticism during the years of the great war 
which was commenced in 1914.* 

A review, therefore, of the changes which took place in 
organization, training, and administration during the period 
between the South African War and the outbreak of war in 
1914 is necessary before the state of readiness of the medical 
services for a war of magnitude in Europe can be adequately 
appreciated. 

After the South African War the arrangements for the care 
of the sick and wounded were examined and reported upon 
by Royal Commissions and inter-departmental and War 
Office committees ; important lessons were subsequently 
learnt from the Russo-Japanese War of 1904-5 ; the Geneva 
Convention of 1906 afforded a basis for further organization 
of voluntary aid ; a new and important position was given 
to the Army Nursing Service ; and the old volunteer and 
militia forces were abolished and a territorial force created. 
The history of the medical services during the European War 
would be incomplete without a record of the special influence 
which each of these circumstances and events had upon the 
Army Medical Service and its state of efficiency when war 
was declared, f 

As regards the administration of the Army Medical Service, 
the nomenclature of administrative medical officers of all 
grades was definitely settled both for peace and war, and 
fitted in with the general changes which took place in 
army organization. This was of much value, especially in 
connection with the field organization and training of 
the medical services, as the new administrative designations 

* The campaigns in Mesopotamia and Gallipoli led to Commissions of 
enquiry. The preparations for the former campaign, however, were under 
the Indian Government and were only partially under the influence of the 
changes which took place in the Army Medical Service under War Office 
administration ; and the defects in arrangements for the care of sick and 
wounded in the latter campaign were due to other causes than those which 
obtained at the time of the South African War. 

t Successive directors-general of the Army Medical Service at the War 
Office during the period of preparation between the South African War and 
the year 1914 were : Sir W. Taylor, to 31st December, 1904 ; Sir Alfred 
Keogh, to 6th March, 1910 ; Sir Launcelotte Gubbins, to 31st May, 1914. 



PREPARATION FOR WAR 3 

provided a clearly defined hierarchy in administrative 
appointments, irrespective of the substantive rank or 
seniority of the officer holding the appointment. 

The term " principal medical officer" was abolished. It had 
given rise to considerable confusion during the South African 
War. The officer in charge of a general hospital, the 
administrative medical officer of a division, of the lines of 
communication, of a base, of an army corps or of a force in the 
field, all bore the same designation, and telegrams, letters, 
field messages and orders occasionally went astray or left 
a doubt as to the principal medical officer to whom 
they referred. A new nomenclature consequently appeared 
in War Establishments published in 1907. The principal 
medical officer of the field force became the director of medical 
services, and his assistant the assistant director of medical 
services ; the principal medical officer of the lines of 
communication was designated the deputy director of medical 
services, and his assistant the deputy assistant director of 
medical services ; the principal medical officer of a division 
was designated " administrative medical officer " of the 
division ; the principal medical officer of a general or other 
hospital the officer commanding the hospital ; and the 
principal medical officer of a base the senior medical officer 
of the base. The term principal medical officer consequently 
ceased to appear in connection with the field force, but it 
was retained for home and overseas commands until 1912, 
when the principal medical officers of all commands were 
designated deputy directors of medical services. At the same 
time the administrative medical officers of the divisions and 
districts were designated assistant directors of medical 
services. 

In the organization of the medical services for administrative 
duties considerable changes also occurred. Until 1904 the 
administration of the War Office was in the hands of a 
Commander-in-Chief and Adjutant-General, with a War 
Office Council and Army Board. The Director-General of the 
Army Medical Department was a member of the War Office 
Council, the other members being the Secretary of State, 
the Under Secretaries of State, the Financial Secretary, the 
Adjutant-General, the Quartermaster-General, the Inspector- 
General of Fortifications, the Director-General of Ordnance, 
and the Director-General of Military Intelligence. In 1904, 
however, on the recommendation of Lord Esher's Committee, 
the post of Commander-in-Chief, the War Office Council, and 
the Army Board were abolished and the administration of the 
War Office put into the hands of an Army Council, but with 

(1735) B 2 



4 MEDICAL HISTORY OF THE WAR 

the Director-General of the Army Medical Service no longer 
a member of the new council. His directorate, which was 
previously an independent directorate, was placed under the 
Adjutant-General, who thus had charge of all questions con- 
nected with the medical services when these came for decision 
before the Army Council. The administration of the Army 
Medical Service consequently became bound up in the ad- 
ministrative work of the Adjutant-General's branch, not only 
in the War Office but also in subordinate commands, and 
the Director-General and his representatives thus lost to 
a great extent their previous independence. 

This new position of the medical services gave rise to a 
considerable amount of criticism and forebodings at the time. 
It was regarded in many quarters as a retrograde step and 
likely to hamper that freedom of action which arrangements 
for sick and wounded demanded, by increasing the difficulties 
of administrative medical officers in obtaining direct informa- 
tion from other branches as to the course of events, the 
intentions of the general staff, and the military situation 
generally. The administrative medical officers were, it was 
felt, losing direct touch with the sources of information on 
these matters. 

In 1904 an Inspector-General of the Forces was appointed 
on the recommendation of Lord Esher's Committee, and an 
Inspector of Medical Services was placed on his staff in 
March, 1907. * His duties were denned by the general principles 
laid down for inspectors in 1904. He was to confine his 
reports to the efficiency and training of the medical services 
for war; to ensure that the methods of training made for 
uniformity ; to watch and form an opinion generally on all 
that affected the readiness of the medical services for war ; 
and to take note of and encourage suggestions for improve- 
ment of training, equipment, and efficiency. 

He was transferred from the staff of the Inspector-General 
to the department of the Adjutant-General at the War Office 
in 1909, and submitted reports of his inspections direct to him 
and not to the Director-General. During the seven years in 
which there was an Inspector of Medical Services previous to 
the war, the officer holding the appointment was able to visit 
all commands at home and abroad f and report on the medical 
arrangements for mobilization and local defence. One of the 

* The post of Inspector of Medical Services was held by Colonel W. Babtie 
from 12th March, 1907, to 5th March, 1910 ; by Colonel M. O'Keeffe from 5th 
March, 1910, to 4th March, 1914, and by Colonel S. Hickson from the last date 
to the outbreak of war. 

f He had no authority to inspect in India. 



PREPARATION FOR WAR 5 

chief advantages of this system of inspection was the oppor- 
tunity it gave for suggesting that what was good in one 
command should be adopted in other commands, thus raising 
as well as rendering more uniform the general standard of 
efficiency. 

Lord Esher's Committee, in their report of 24th February, 
1904, pointed out that there was at that time a great deal of 
information as regards technical military progress in other 
countries, and recommended that an officer of the Royal 
Army Medical Corps should be attached to the section of 
the directorate of military operations which dealt with intelli- 
gence. A medical section of the directorate of military 
operations was consequently formed at the end of 1905 after 
the Manchurian campaign.* Subsequently in 1908 an officer 
on the retired list of the Royal Army Medical Corps f was 
attached to the directorate of military training in connection 
with the Royal Army Medical Corps section of the Officers 
Training Corps. There were thus, for the first time in War 
Office administration, two officers of the medical service 
attached to the general staff, an innovation leading to 
important results in the organization and training of the 
medical services for war. 

In 1901, owing largely to public criticism, two inter-depart- 
mental committees were appointed under the chairmanship 
of Mr. Brodrick, who was then Secretary of State for War, 
one to consider the reorganization of the Army Medical 
Service and the other to consider the reorganization of the 
Army and Indian nursing services. The reports of these 
committees resulted in further additions to the administrative 
control of the medical services at the War Office. 

The committee on the reorganization of the medical services 
recommended, amongst other things, the formation of an 
advisory board, which was to have complete supervision of 
the Royal Army Medical Corps and control the Royal Army 
Medical Corps examinations. An advisory board for medical 
services was consequently constituted in 1902. It consisted 
of two officers of the R.A.M.C., the one an expert in sanitation 
and the other an expert in tropical diseases, a representative 
of the Quartermaster-General's department, an officer of the 
Indian Medical Service, and four civil medical men, with the 
Director- General and Deputy Director-General as members 

* Report of Lord Esher's Committee, Part II, Sect. IV, para. 26. The 
appointment was held by Lieut. -Colonel W. G. Macpherson from 1906 to 1910 ; 
by Major C. E. Pollock from 1910 to 1914, and by Major J. V. Forrest from 
1914 to outbreak of war. 

| Lieut. -Colonel H. E. R. James. 



6 MEDICAL HISTORY OF THE WAR 

ex officio.* The extent to which this board should exercise 
administrative control was not clearly denned at the time, and 
the introduction of a civil element into the administration 
of the Army Medical Service created some misgivings, which 
were but re-echoes of the past, as may be gathered from the 
fact that a suggestion made by the Government in 1855 to 
vest the governing power of the Army Medical Department 
in a medical board with a civil element had been rejected 
by a select committee of the House of Commons in 1856 
on account of the strong feeling against it amongst army 
medical officers, and also from the fact that the inefficiency 
of the medical services at the time of the Walcheren 
Expedition in 1805 was attributed to administration by a 
civil medical board. 

These misgivings were eventually set at rest in 1907 by 
a reconstitution of the advisory board for medical services 
under the designation " Army Medical Advisory Board " with 
clearly denned functions. It was to have no administrative 
control nor could it take administrative action. It was to 
advise on medical, hospital and sanitary matters only, thus 
taking over duties previously carried out by the Army 
Sanitary Committee which came into existence after the 
Crimean War, and by the Army Hospital Committee which 
was formed in 1903 to advise on the provision and equipment 
of military hospitals. These two committees had been 
amalgamated in 1906 in an " Army Hospitals and Sanitary 
Committee," and it was this committee which was absorbed 
into the Army Medical Advisory Board in 1907. 

The committee on the reorganization of the Army and 
Indian Nursing Service resulted in the disappearance of the 
old army nursing service and its reconstitution in March 
1902f as the " Queen Alexandra's Imperial Military Nursing 
Service." A nursing board was then formed at the War 



* The constitution of this board appeared for the first time in the A rmy 
List for May, 1902. The members then were : 

Surgeon-General Sir Wm. Taylor, D.G., A.M.S. 

Surgeon-General A. Keogh, D.D.G., A.M.S. 

Lieut. -Colonel D. Bruce (expert in tropical diseases). 

Major W. G. Macpherson (expert in sanitation). 

Surgeon-General Hooper, representing the Indian Medical Service. 

Colonel W. A. Dunne, A.Q.M.G., representing the War Office. 

Sir F. Treves. 

Dr. C. Ball. 

Dr. E. C. Perry. 

A. D. Fripp, Esq. 

Dr. J. Galloway. 

The Matron-in-Chief was also a member of the board when Nursing 
Service questions arose. 
I Army Order 67 of 1902 



PREPARATION FOR WAR 7 

Office with a civil element on it, analogous to the advisory 
board for medical services, and a Matron-in-Chief was 
appointed for the first time to the staff of the Director- 
General of the Medical Service.* 

In the period therefore between the South African War and 
the outbreak of war in 1914 the following important changes 
had been effected in the administration of the medical services. 

The nomenclature of administrative appointments for 
commands at home, abroad, and in the field was converted 
into a clearly defined administrative hierarchy, consisting 
of a D.M.S., D.Ds.M.S., A.Ds.M.S., and D.A.Ds.M.S. 

The administration of the Director-General's branch at 
the War Office was placed under the Adjutant-General, who 
represented the medical services on the Army Council. 

An Inspector of Medical Services was appointed to the 
staff of the Inspector-General of the Forces and subsequently 
to the Adjutant-General's Department. 

A medical section was formed in the directorates of military 
operations and of military training in the General Staff 
branch of the War Office. 

An Army Medical Advisory Board with a civilian element 
was constituted to advise on technical medical and sanitary 
matters. 

The administration of the army nursing service was placed 
in the hands of a Matron-in-Chief, as head of a nursing 
section at the War Office, under the Director-General, and 
a nursing board was constituted. 

At the time of the South African War the field medical 
organization differed in many important details from the 
organization which was subsequently established. The 
medical units, for which there were, on paper, fixed establish- 
ments, consisted at that time of bearer companies, field 
hospitals, stationary and general hospitals, advanced and base 
depots of medical stores, hospital trains and hospital ships. 
Convalescent depots were not provided for nor were there 
special sanitary units, but an organization for the reception 
and distribution of sick and wounded on arrival in the 
United Kingdom was formed in connection with the war, 
and the organization of voluntary aid had been taken in hand. 

Each brigade in the field had, as part of its composition, 
one bearer company and one field hospital, and each division 
one field hospital, the field hospital being organized for 
100 sick and wounded. These units were independent of one 

* The post of Matron-in-Chief was held by Miss Sidney Browne from 
April, 1902, to April, 1906, Miss C. H. Keer from April, 1906, to April, 1910, 
and Miss E. H. Becher from April, 1910, to August, 1919. 



8 MEDICAL HISTORY OF THE WAR 

another. Not only was there an absence of adequate co- 
operation in the brigade between the officer commanding the 
bearer company and the officer commanding the field hospital, 
but also friction occasionally arose from the fact that at one 
time the bearer company commander, and at another the 
field hospital commander, might be the senior medical 
officer of the brigade. This led to administrative confusion. 
It was in the power of the administrative medical officer of 
the division to insist upon adequate co-operation of the 
medical units of the brigades, but his power of control did 
not appear to have been exercised sufficiently, and the 
situation, as it then existed, cried out for reform. During 
the final phases of the South African War, when the British 
force was split up into small columns and waging a guerrilla 
warfare, it was found necessary to reconstitute this organiza- 
tion of field medical units, and small medical units were 
formed to accompany the columns by amalgamating sections 
of bearer companies and field hospitals in one unit. 

In 1901 a War Office committee, of which Colonel Heath 
was president, considered these points, and recommended that 
the functions of the bearer company and field hospitals should 
be combined in one unit,, but it was not until the year 1905 
that effect was given to this recommendation. The new unit 
was the field ambulance, and it ceased to be a brigade unit. 
Two field ambulances were allotted as divisional troops to 
each division, and one field ambulance as corps troops to an 
army corps, thus replacing the two bearer companies and 
three field hospitals which were the medical units within the 
division previously. At the same time a field ambulance was 
specially organized for a cavalry or mounted brigade, com- 
bining also the functions of the former bearer company and 
field hospital. 

The organization of these new units was in some respects 
complicated. They were divided into bearer divisions and tent 
divisions, the former of which consisted of stretcher bearers 
only, without equipment for ambulance transport, and without 
an advanced dressing station or collecting post party. The tent 
division gathered in all the remaining elements of the unit, 
including its ambulance transport. A field ambulance was 
further divisible into three sections, each section consisting 
of one-third of the bearer division and one-third of the tent 
division, designated respectively bearer subdivision and tent 
subdivision, but in the case of the cavalry and mounted 
brigade field ambulance the unit was divided into two sections 
only. 

The ambulance transport of field ambulances and cavalry 



PREPARATION FOR WAR 9 

field ambulances consisted of ten ambulance wagons. In the 
former units all of the wagons were of one type for four 
lying-down cases or twelve sitting ; in the latter four were light 
ambulance wagons for two lying or six sitting, and six were 
heavy ambulance wagons for four lying or twelve sitting. 

The field and cavalry field ambulances were equipped to 
accommodate 50 sick and wounded in each section, or a total 
of 150 patients in the former and 100 in the latter. 

Apart from the regimental medical service, consisting of one 
medical officer with each battalion, cavalry regiment, brigade 
of artillery and smaller units or groups of smaller units, these 
ambulances represented the whole medical organization in 
front of the lines of communication for an army in the field 
as reconstructed in 1905. In the mobilization instructions 
and field army tables issued in that year provision was 
made for a cavalry field ambulance to each of three cavalry 
brigades, two field ambulances to each of three divisions, and 
a field ambulance to troops of one corps. Two field ambulances 
were also authorized for a 4th and 5th Division, and fourteen 
stationary and ten general hospitals, two advanced and two 
base depots of medical stores, two ambulance trains, and two 
hospital ships were allotted to the lines of communication. 

The Russo-Japanese War had now ended, and its lessons 
were being examined by the recently constituted General 
Staff at the War Office, and, as regards the organization of 
medical services for a war of similar magnitude, by the 
medical section in the directorate of military operations. As 
compared with the field medical organization of the Russian 
and Japanese armies, and in fact of Continental armies 
generally, the organization evolved from the lessons of the 
South African War was considered inadequate for the rapid 
collection and evacuation of the large numbers of wounded 
which it was anticipated would be thrown on the field 
ambulances at any moment in a European war. With four 
divisions only engaged in battle the number of wounded 
might readily be 20,000 in one day.* 

In a war of movement it was anticipated that the field 

* In none of the battles of the South African War did the number of 
wounded exceed 1,000, with the exception of Spion Kop, when the number 
was 65 officers and 969 other ranks wounded between the 17th and 24th 
January, 1900 ; during 'the march of Lord Roberts' force from the Modder 
River to Bloemfontein, llth February to 13th March, 1900, when the 
number, including the wounded at Paardeberg, was 119 officers and 1,663 
other ranks ; and in the operations for the relief of Ladysmith, when the 
number of wounded between 14th and 27th February, 1900, was 100 officers 
and 1,762 other ranks. The total number of wounded during the whole war 
from 9th October, 1899, to 31st May, 1902, was 1,758 officers and 19,399 other 
ranks. 



10 MEDICAL HISTORY OF THE WAR 

ambulances would consequently become rapidly congested 
and rendered immobile unless they were in close touch with 
other units to which the wounded could be transferred 
previous to their evacuation to the hospitals on the lines 
of communication. Representations on this point were made 
by the general staff and resulted in a new unit, called the 
clearing hospital, being introduced into war establishments 
as a link between the divisions in the field and the lines of 
communication. Zones of work, following the Continental 
system, for collection, evacuation and distribution of sick and 
wounded to permanent hospitals were defined. The field 
ambulances and regimental medical service were recognized 
as the medical units for collecting wounded, the clearing 
hospitals and ambulance trains the units for receiving wounded 
from the collecting zone and evacuating them to the base ; 
stationary and general hospitals and the hospitals in the 
United Kingdom the units to which they would be distributed 
from this evacuating zone for permanent treatment. It was 
urged that the new clearing hospital unit should have its own 
transport to enable it to follow up the field ambulances 
as they advanced and maintain a constant link between 
them and the line of railway. It was also urged that there 
should be an ambulance convoy associated with it for 
bringing wounded from the field ambulance to the clearing 
hospital, and from the clearing hospital to the ambulance 
train. These proposals, however, were rejected by the Army 
Council at the time, as they involved an increase of transport 
already assuming unwieldy proportions in the field.* The 
method by which clearing hospitals were created was also 
not altogether satisfactory. A number of the stationary 
hospitals, already allotted to the lines of communication, 
were designated clearing hospitals, without alteration in 
their organization. The stationary hospitals, which had 
formerly been equipped for 100 beds, had been organized in 
1905 as units for 200 beds. The clearing hospital thus 
became a unit for 200 beds, but was given a modified 
equipment with field stretchers instead of beds and without 
nursing sisters. 

From a General Staff point of view misgivings existed 
regarding the efficiency of this compromise, and the 
opportunity was taken by the medical section of the 
directorate of military operations, in reviewing, in April, 1907, 
the reports of the military observers of the United States 
Army attached to the armies in Manchuria during the 

* A War Office committee under Major-General Stopford was considering 
at the time a reduction in transport and field equipment. 



PREPARATION FOR WAR 11 

Russo-Japanese War, to submit a long memorandum, which 
raised the general question as to whether the medical service 
was, in a military sense, fit for war. It was pointed out in this 
memorandum that the chief defects consisted in insufficient 
organization for evacuation of sick and wounded from the 
field ambulances, insufficient organization of voluntary aid as 
supplementary to the Army Medical Service, and inadequate 
provision for training of Royal Army Medical Corps officers 
in their administrative duties in the field. The number of 
clearing hospitals which had been sanctioned was six, or in 
the proportion of one for each division in the field, but no 
arrangements were made for rendering them mobile, except 
by transport which might or might not be available on 
requisition, and there was no ambulance or other transport 
definitely allotted to the medical services to work between 
the field ambulances and the clearing hospitals. It was 
pointed out that the clearing hospital as organized accom- 
modated only 200 sick and wounded, whereas it should be 
large enough to take over the sick and wounded from all 
field ambulances of a division. It was also urged that it 
should be made mobile enough to be pushed forward rapidly, 
and that there should be a special organization of ambulance 
transport from field ambulances to railhead. The experience 
of previous campaigns was against obtaining transport for 
this purpose by requisition on other branches of the service. 
A War Office committee was appointed to consider this 
memorandum, under the chairmanship of the Director-General 
of the Army Medical Service, with representatives of the 
General Staff and Quartermaster-General, the officer in charge 
of medical mobilization, and the officer in charge of the medical 
section of the directorate of military operations as members. 
They reported that they were unanimously of opinion that, 
under conditions of severe fighting or of fighting prolonged 
over several days and considerable distances, the existing 
organization was inadequate to ensure rapid evacuation of 
the sick and wounded from the field armies, and recom- 
mended that, in order to effect greater efficiency in this 
direction, the clearing hospital should be made a mobile unit, 
with a definite scale of personnel and material for its trans- 
port, and that a transport section should be formed for 
the purpose of evacuating sick and wounded from field 
ambulances to clearing hospitals and from clearing hospitals 
to railhead. It was suggested that the section should be 
designated the " sick and wounded convoy section " and 
have a cadre establishment of one officer and two non- 
commissioned officers of the R.A.M.C., with such transport 



12 MEDICAL HISTORY OF THE WAR 

personnel as might afterwards be determined. It was further 
suggested that the nucleus of this convoy might be formed 
by the transport vehicles of the clearing hospital after they 
had been unloaded and that a specially selected warrant 
officer of the Army Service Corps should be placed in charge 
of them for the purpose. The amount of transport which it 
was estimated would be required to render a clearing hospital 
mobile was 20 wagons, including transport of supplies for 
personnel and animals. The military members of the Army 
Council considered, however, that it was not necessary to 
make any provision for transport to be exclusively assigned 
to the medical services for the purpose indicated, although 
the requirements should be recognized and met, if possible, 
by utilizing local resources as well as the wagons bringing up 
supplies to the troops, of which there would be a large 
number returning empty and available for evacuation of sick 
and wounded from the field ambulances. In view of the 
subsequent development of clearing hospitals and ambulance 
convoys during the European war, this history of the 
origin of the casualty clearing station and its anticipated 
requirements is of special interest. 

In November, 1908, the provision of motor ambulances was 
considered by the advisory board for inclusion in the 
estimates of 1909-10, but the provision recommended was 
a meagre one. It referred to peace requirements only and did 
not mark any advance in organization for motor transport 
of sick and wounded in war. 

But if the changes in field medical organization, as thus 
finally adopted in 1907, did not altogether allay the mis- 
givings regarding the provision for collecting and evacuating 
wounded in the event of a great war, the lessons of previous 
campaigns had specially emphasized the necessity of an 
organization for the prevention of disease. At the time of 
the South African War there was no independent sanitary 
organization in the army. The medical officers with fighting 
units and administrative medical officers were responsible 
advisors of unit and formation commanders regarding the 
measures for preventing disease. Medical officers generally 
were charged with the duty of sanitary inspections, but there 
was no trained sanitary personnel under their .control, or 
indeed anywhere. The need for better organization for 
preventing disease was brought to notice by a Royal 
Commission appointed in 1901, under the chairmanship of 
Lord Romer, to enquire into the arrangements for the care 
of the sick and wounded in the South African W T ar. The 
recommendations of this Commission on the subject of 



PREPARATION FOR WAR 13 

sanitation did not, however, go very far. They merely 
recommended the appointment of properly qualified officers 
of the R.A.M.C. to undertake sanitary duties. 

Mr. Brodrick's committee, which followed, gave no detailed 
scheme for the organization of sanitary services and confined 
itself to the general recommendation that there should be 
specialist appointments in the R.A.M.C. But one of the 
members of the committee, Dr. Ogston, in a supplementary 
note took exception to the report of the Committee as 
a whole, because, amongst other points, it did not provide 
for the formation of a sanitary corps of officers for carrying 
out proper sanitary measures in peace and war. 

In 1904, Lord Esher's committee, in recommending that an 
officer of the R.A.M.C. should be attached to the directorate 
of military operations, specially defined his duty as that of 
supplying information on new developments in military 
hygiene, but made no further reference to sanitary organiza- 
tion beyond the general statement that sanitation in war and 
peace was closely bound up with discipline and that this 
constituted a reason why the proper position of the Director- 
General of the Army Medical Service should be under the 
Adjutant-General. 

The advisory board for medical services, appointed in 
1901 on the recommendation of Mr. Brodrick's committee, 
dealt with the subject of sanitation in much the same way 
in its earlier meetings. The old Army Board, of which the 
Director-General, Army Medical Service, was a member, had 
already, in February, 1901, recommended that medical officers 
specially charged with sanitary duties should be included in 
war establishments of the staffs of both army corps and 
divisions in the field, and that every effort should be made to 
impress the importance of the subject of sanitation upon 
officers and men of the army. The newly appointed advisory 
board for medical services endorsed this recommendation at 
its sixth meeting in February, 1902, but rejected Dr. Ogston's 
proposal to form a special sanitary corps. 

A scheme for the appointment of specialist sanitary officers 
to nineteen commands or districts at home and abroad, 
including five already allotted to the R.A.M.C. in India, 
was subsequently submitted to the Army Council by the 
advisory board in January, 1902. But it was not till 1905 
that any definite progress was made in the general organization 
for prevention of disease. In that year a syllabus of three 
lectures on sanitation in the field was drawn up and approved 
by the Army Council for delivery each term at the Royal 
Military Academy, Woolwich, and the Royal Military 



14 MEDICAL HISTORY OF THE WAR 

College, Sandhurst. These lectures were elementary, but more 
advanced lectures were the same year arranged to be given 
at the Staff College.* The advisory board for medical 
services at the time resisted any attempt to reduce the amount 
of teaching of this all-important subject. 

In the following year, 1906, the advisory board considered 
that the time had now arrived to undertake a systematic 
survey of the whole subject of the prevention of disease 
in war and the organization and sanitary measures required 
for this purpose. A committee was consequently formed to 
investigate the influence of clothing, external temperature, 
food, and exertion on bodily condition and on the physical 
training of recruits. This committee continued to investigate 
and report on these subjects during the following years and 
did not complete its labours until 1909. 

At the same time the Director-General and his staff had 
been working out schemes and equipment for providing 
a pure or purified water supply to troops in the field and for 
sanitary measures generally. 

The organization required for supplying pure water to 
troops in the field at all times had been specially dealt with 
by the advisory board in a report on the subject submitted 
to the Secretary of State for War in February, 1902. The 
public mind had become obsessed at that time with the idea 
that the extensive and fatal prevalence of enteric fever during 
the South African War was due to polluted water supplies 
and to no other causes. Irresponsible writers flooded the 
public press with articles on the subject. A scientific com- 
mittee appointed by the War Office to consider the incidence 
of dysentery at the time of the South African War was not 
exempt from the error of ignoring other causes and devoted 
most of its report to the provision of a pure or purified water 
supply in the field. 

At the time of the Russo-Japanese War the subject was 
still further emphasized in press communications and in 
articles by writers with no special knowledge. It was 
assumed, although on no logical basis, that the Japanese in 
that campaign were remarkably free from disease ; the only 
argument brought forward being that the proportion of deaths 
from disease was less than that of deaths from wounds. 
The Japanese, in fact, were not more free from preventable 
disease in the Russo-Japanese War than the British in South 
Africa ;f but both British and American writers assumed that 

* Major R. H. Firth was appointed lecturer. 

f See Medical and Sanitary reports by officers attached to Russian and 
Japanese armies during the Russo-Japanese War, Report No. 16. 



PREPARATION FOR WAR 15 

diseases must have been few because the battle casualties, 
which were exceptionally heavy, exceeded the number of sick. 
Extravagant and imaginative descriptions were published 
of the way in which the Japanese medical officers went on 
in front of the troops in the field with a view to examining the 
water supplies microscopically before they could be declared 
safe for the advancing troops, which was not in fact the case. 

The organization for providing a pure water supply at all 
times consequently assumed large proportions in the prepara- 
tion of the British Army for war in the future. Special water 
carts with sterilizing apparatus were designed and a non- 
commissioned officer and men of the Royal Army Medical 
Corps, the latter in the proportion of two to each cart, were 
added to the war establishments of each unit in the field 
for their care and management. This was an entirely new 
and important advance in organization for field sanitation. 

But the scheme of sanitation in the field fortunately did 
not stop short of ensuring the purification of water supplies. 
Each unit in the field was to form from its combatant personnel 
a sanitary detachment of'one non-commissioned officer and 
eight men for regiments and battalions, and four men for 
smaller units, whose duty was to attend to all matters of 
sanitation within the unit, its camps and billets when in the 
field, and to act as the sanitary police of the unit. With 
troops operating against an enemy it was desirable that 
sanitation should be the concern of each unit and of each 
individual in it, and the officer commanding the unit was made 
responsible for this.* 

On the lines of communication the conditions were different. 
The various camps and billets were more or less permanent 
establishments but the population in occupation of them was 
constantly changing. Troops would arrive and move on 
again at any hour of the day or night. It was not possible, 
therefore, to place the responsibility of maintaining sanitation 
in the permanent camps on the officers commanding these 
migratory units. Still less could they be made responsible 
for the maintenance of permanent water supplies and sanitary 
constructions. 

To meet the conditions, therefore, on the lines of communi- 
cation sanitary sections and sanitary squads were introduced 
into war establishments as special technical units of the 
R.A.M.C. They were to be responsible for all sanitary 
executive work in connection with the camps at ports of 

* An Army school of sanitation was established at Aldershot for instruction 
of the sanitary detachments, and an official manual of sanitation was published 
as the text- book for officers and other ranks. 



16 MEDICAL HISTORY OF THE WAR 

embarkation and disembarkation, at railheads, in the various 
rest camps, and at entraining and detraining stations along 
the lines of communication. 

Finally, provision was made for the appointment of a sanitary 
commission consisting of a general officer, an officer of the 
Royal Engineers and an officer of the R.A.M.C., whose duties 
were to deal with the larger problems of sanitation in an area 
of operations, co-ordinating civil and military sanitation 
within it and advising generally on important sanitary work. 

The question of making anti-typhoid inoculation compulsory 
was considered by the advisory board in February, 1912. 
The board considered that despite the most careful sanitary 
organization there must continue to be grave danger of 
typhoid fever becoming epidemic during operations in the 
field, and expressed the opinion that, in view of the increased 
resistance to infection conferred by anti-typhoid inoculation 
and the impossibility of inoculating the expeditionary force 
after mobilization was ordered, the only method of securing 
the maximum of immunity would be by the adoption of anti- 
typhoid inoculation as a routine matter in times of peace. 
The board, therefore, strongly recommended to the Army 
Council that these anti-typhoid inoculations should be made 
compulsory for all soldiers on attaining the age and service 
at which they become available for active and foreign service ; 
they drew attention to the procedure then adopted in the 
Army of the United States of America and the results obtained 
during its recent mobilization on the Mexican frontier. The 
Army Council, however, did not consider it advisable that 
anti-typhoid inoculation should be made compulsory, but 
directed that the soldier should be encouraged by lectures 
and by leaflets to take advantage of the safety conferred by it. 

In March, 1908, the attention of the advisory board was 
drawn to the small number of appointments for officers 
qualifying as specialists in bacteriology. At that time there 
were only four of these appointments at home and two 
abroad, although thirty-one officers had qualified as 
specialists. Of these only eight were employed as clinical 
pathologists or on special research work, and, of the remainder, 
fourteen were employed on ordinary duty and nine in sanitary 
work. Specialist pay was only granted to the clinical 
pathologist at certain large hospitals. The advisory board 
consequently recommended the appointment of a clinical 
pathologist to all hospitals containing 100 beds or over, but 
no special steps were taken at the time to increase the number 
of appointments for bacteriological work in the army. 

The next important advance in the organization of the 



PREPARATION FOR WAR 17 

medical services for a war in Europe was the organization 
for the disposal of convalescents. The want of a definite 
organization and procedure regarding the despatch and 
disposal of invalids and their documents from the base of 
operations gave rise to much confusion during the South 
African War. The question of the principles which should 
guide the military authorities in sending invalids to the 
United Kingdom in any future war of magnitude was raised 
in 1904 ; and in June, 1905, a committee was formed at the 
War Office to consider and report on the general rules which 
should be followed. The committee submitted its report in 
July of that year. For the purpose of disposal and 
distribution four classes of invalids were recognized : 

(1) Those requiring hospital treatment on disembarkation. 

(2) Those not in need of hospital treatment but requiring 

medical care and observation. 

(3) Those sufficiently recovered to ^proceed on sick 

furlough. 

(4) Those reported fit for duty at the end of the voyage. 

For the first class, hospital accommodation had to be 
provided. Under the conditions then existing it was 
estimated that 5,000 beds were likely to be available in the 
military hospitals in the United Kingdom, and this represented 
the maximum number of invalids from the South African War 
who were in hospitals in the United Kingdom at any one 
time out of a force of 220,000. But a scheme of hospital 
centralization, which was then being submitted by the 
advisory board for medical services, would result in reducing 
the probable number of available beds for sick and wounded 
from overseas to 800. The total number of beds in military 
hospitals at the time was 9,600, and the centralization scheme 
proposed their reduction to 5,300, of which 4,500 were 
constantly occupied by the sick of the home army. 

The expansion of hospital accommodation in time of war 
was consequently a matter for serious consideration, but the 
War Office committee made the very optimistic estimate that 
a contract made on the outbreak of hostilities would secure in 
a few weeks the erection of as many huts as might be required 
to provide temporary hospital accommodation. It was 
forgotten that only with great difficulty could any such 
expansion be obtained at the time of the South African War. 
The immediate requirements for the reception of invalids 
were only met then by obtaining a large number of portable 
Doecker huts from the Central Red Cross Committee of 
Germany. A hutted hospital at Alton which the " Absent 

(1735) C 



18 MEDICAL HISTORY OF THE WAR 

Minded Beggars " fund hoped to erect in a month or two took 
two years to complete. Without definite preparation, 
therefore, beforehand, with material ear-marked for the 
purpose and with sites considered and prepared in advance, 
it was far from probable that a contract for hospital 
accommodation on the outbreak of hostilities would meet 
the immediate demands of a war in Europe. In the armies 
of Europe the planning and equipment of public buildings 
and barracks as hospitals in the event of war had been 
thoroughly considered and scheduled. In the United States 
of America plans and specifications of hospitals and 
convalescent depots had also been prepared in the Surgeon- 
General's office. The Japanese had made provision previous 
to the Manchurian War for expanding their military hospitals 
rapidly from 200 to 10,000 and even 15,000 beds each by the 
erection of temporary huts whenever war broke out. All this 
was in marked contrast with the want of preparation in the 
United Kingdom.' The importance of the subject was still 
further emphasized by the fact that in the early months of 
a European war the number of sick and wounded evacuated 
to England would probably be ten times as many as had been 
evacuated during the South African War. The expansion 
of hospital accommodation effected during that war amounted 
to 2,000 beds only. 

The War Office committee of 1905 did not, however, 
provide a scheme to meet these requirements but proposed 
that the invalids who did not require hospital treatment 
should be received into a special disposal depot which would 
be mobilized in each of the grouped regimental districts. The 
suggestion was that a barrack should be set apart for the 
accommodation of the disposal depot and a special staff 
appointed to. it. Invalids sent to it, who might require 
medical care, would remain in the depot under the supervision 
of the medical officers normally quartered in the neighbourhood 
or of one or more appointed to the special staff of the depot 
for the purpose. In the event of this barrack accommodation 
proving insufficient it was to be supplemented by the erection 
of temporary huts. The advantage of the scheme was that 
the destination of each invalid would be clearly defined on 
disembarkation or on discharge from hospital as a convalescent. 

In November, 1905, the Army Council approved of these 
principles, but nothing further was done beyond the suggestion 
that some general instructions should be drawn up for 
inclusion in mobilization regulations ; and arrangements 
were consequently made in 1906 for including convalescent 
depot units in war establishments. The subject was lost 



PREPARATION FOR WAR 19 

sight of, however, and not taken up in any definite form until 
December, 1908, when the necessity of having plans prepared 
beforehand for the formation of convalescent depots in the 
field and at home was strongly urged by the Director-General 
and by the medical section of the directorate of military 
operations. The subject was discussed in conferences and 
committees at the War Office during 1909, 1910 and 1911, 
and eventually the Army Council approved of a scheme by 
which 4,750 beds in barracks at Lichfield, Winchester, 
Shorncliffe, and Warley should be handed over to the medical 
authorities as convalescent depots on mobilization. If the 
barrack accommodation was not available, as was highly 
probable, the convalescent depots were to be accommodated 
in huts, or, if the season permitted, in tents. The question 
of hutting was to be left till mobilization was ordered. In 
the meantime standard plans for convalescent depots of 
1,000 and 500 beds were prepared and approved. . 

It was not, however, until 1914 that a convalescent 
depot was shown in war establishments and mobilization 
instructions as a unit of the R.A.M.C. 



(1735) C2 



CHAPTER II 

THE PREPARATION OF THE ARMY MEDICAL SERVICE 
FOR WAR (cont.) 

PERSONNEL AND TRAINING. 

E organization of an expeditionary force for service 
-L abroad was published in a special Army Order of 
1st January, 1907. The force consisted of a cavalry division 
of four brigades, six divisions each of three infantry brigades, 
four artillery brigades, engineers and divisional mounted 
troops, and army troops which included two mounted 
brigades. The medical units allotted to this force were fouf 
cavalry field ambulances to the cavalry division, a cavalry 
field ambulance to each of the mounted brigades, three field 
ambulances to each of the divisions, and two field ambulances 
to the army troops. For the lines of communication 
provision was made for six clearing hospitals, twelve 
stationary and twelve general hospitals, three advanced 
and three base depots of medical stores, six ambulance 
trains and six hospital ships, two sanitary sections and eleven 
sanitary squads. This remained as the general allotment of 
medical units for the expeditionary force until the outbreak 
of war, the only modification being the withdrawal of the 
cavalry field ambulances from the mounted brigades when 
these ceased to form part of the force in 1914, the reduction 
of the number of hospital ships from six to three in 1913 
on account of the short voyages likely to be required for an 
expeditionary force on the continent of Europe, and the 
addition of a convalescent depot to lines of communication 
units in 1914. A fifth cavalry brigade was added in 1914 
on the withdrawal of the mounted brigades, and a cavalry 
field ambulance was allotted to it. 

For the expeditionary force, therefore, provision had been 
made in January, 1914, for the regimental medical services 
of the headquarters of a cavalry division and 21 units of 
cavalry or cavalry divisional troops ; for the headquarters 
of 6 divisions, 72 infantry battalions and 72 units of divisional 
troops ; for general headquarters, headquarters of 2 armies, 
and 24 units of army troops including the headquarters and 
4 squadrons of the Royal Flying Corps and line of commu- 
nication troops ; for 5 cavalry field ambulances and 20 field 

20 



PREPARATION FOR WAR 21 

ambulances, 6 clearing hospitals, 12 stationary hospitals, 
12 general hospitals, 1 convalescent depot, 6 ambulance 
trains, 3 hospital ships, 3 advanced depots of medical 
stores, 3 base depots of medical stores, 2 sanitary sections 
and 11 sanitary squads. 

The problem which the Director-General of the Army 
Medical Services had from the first to face was the provision 
in the event of war of personnel for all these units as 
well as for the medical services in the United Kingdom 
and garrisons overseas. As already noted, the Army 
Medical Service at the time of the South African War 
was barely sufficient for peace requirements and possessed 
no organization for expansion in war. The most notice- 
able comment of the Royal Commission appointed under 
the chairmanship of Lord Elgin in 1903 to report upon 
the South African War was that " the true lesson of the 
war, in our opinion, is that no military system would 
be satisfactory which does not contain powers of expan- 
sion outside the limit of the regular forces whatever that 
limit may be." Two problems then confronted the Director- 
General : one the fixing of a limit for officers and men of 
the regular establishment of the Royal Army Medical 
Corps, and the other the organization of a system for meeting 
the expansion which would be necessary on the outbreak of 
war. None of the medical units enumerated above and none 
of the medical services of the regimental units with the excep- 
tion of those of the Household Cavalry and Guards battalions 
existed in time of peace. Provision had to be made for their 
mobilization in time of war. In the preparation for a conflict 
in Europe one of the most pressing needs, therefore, was 
that of an adequate personnel to mobilize with the regimental 
units of the expeditionary force, and to provide the estab- 
lishment of the medical units which would come into being 
at the same time. 

In considering the questions that arose the problem was 
found to be difficult and complicated The Director-General 
was assisted in his consideration of it by the advisory board 
for medical services, who took up the question by direction 
of the Secretary of State in 1903 and submitted four reports 
to him on the subject in 1904. Conferences were also held 
with the volunteer and militia medical services and with 
representatives of voluntary aid associations. The out- 
standing feature of the discussions and reports was to the 
effect that the normal strength of officers of the R.A.M.C. 
was several hundreds and of other ranks several thousands 
below the requirements of an Expeditionary Force of 140,000 



22 MEDICAL HISTORY OF THE WAR 

The advisory board, in submitting these facts to the Secretary 
of State in October, 1904, remarked " that until a large increase 
of R.A.M.C. personnel in officers, non-commissioned officers 
and men is sanctioned, this country must be prepared to face 
a European campaign with totally inadequate means of dealing 
with the sick and wounded in a satisfactory manner." 

It was obvious, however, that, as regards officers, expansion 
must take the form of employment of civil surgeons, and, as 
regards other ranks, of partially trained men from voluntary- 
aid or other volunteer sources. The advisory board placed 
a limit on the proportion of these. The proportion of regular 
R.A.M.C. officers with the expeditionary force was fixed 
at 55 per cent, and of civil surgeons at 45 per cent.; and the 
proportion of trained subordinate personnel at 64 per cent, 
and of partially trained at 36 per cent. In 1904, when 
the advisory board's report was submitted, the expeditionary 
force organization was that of three army corps and three 
cavalry brigades. It was estimated that 1,023 medical officers 
would be required for it, of whom 576 would be regular officers 
and 447 civil surgeons according to the above proportion. 
But at that time only 397 regular R.A.M.C. officers were 
available for mobilization, after making allowance for the 
numbers who would be necessary for the administrative and 
other duties in the United Kingdom and for garrisons overseas, 
including India. To fill up the gaps by employing untrained 
civil surgeons, who might volunteer on the outbreak of war, 
was considered inadvisable. The utility of civil surgeons 
was greatly limited during the South African War by their 
ignorance of military work, while their engagement while 
war was going on was attended with very great disadvantages. 
To meet the situation, therefore, the advisory board recom- 
mended an increase of 179 to the establishment of regular 
R.A.M.C. officers and the formation of an Army Medical 
Reserve of civil surgeons, who should be commissioned in 
time of peace, be liable for general service in time of war, 
receive an annual retaining fee, and undergo such training as 
would fit them for their duty on mobilization. The age limit 
was to be from 21 to 30 years, and the conditions of service 
three and a half years as lieutenant, with two months' special 
training on joining, with option to engage for a further 
three and a half years as captain, provided the applicant 
passed an examination for promotion and had an additional 
month's special training. The Treasury eventually gave its 
assent and the formation of an Army Medical Reserve of 
Officers was published in November, 1906 1 * 

* Army Order 253, 1906. 



PREPARATION FOR WAR 23 

The other personnel of the R.A.M.C. required for the 
mobilization of the 3 army corps and 3 cavalry brigades 
were 72 quartermasters and 9,081 warrant officers, non- 
commissioned officers and men. The strength available on 
mobilization at the time was only 34 quartermasters and 
3,579 other ranks. The advisory board in their report 
considered that, allowing for the maximum proportion of 
partially trained men from voluntary aid sources who, 
consistent with efficiency, might safely be used a number 
estimated at 3,306 there was a deficiency in technically 
trained R.A.M.C. of 38 quartermasters and 2,196 other ranks. 
The existing establishment of the R.A.M.C. had been " based 
on the distribution of the personnel among the various 
military districts according to the peace requirements of the 
troops normally quartered therein and bore no relation to the 
necessities of war." The board considered that there was an 
imperative necessity therefore for the maintenance in peace 
of sufficient establishment to form a nucleus round which 
voluntary aid organizations might be enabled to group 
themselves in each army corps. An increase of 1,719 men 
in the regular establishment of the R.A.M.C. was consequently 
recommended on the assumption that this increase would 
provide in due course a sufficient number of reservists to 
complete the deficiency. This proposed increase, although 
in excess of what was required in peace, was justified by the 
fact that during peace manoeuvres, annual training, and the 
period of colonial reliefs, the establishments in hospitals were 
greatly reduced and had to be supplemented by employment 
of pensioners, civilians and regimental orderlies obtained 
from battalions, men, in other words, who, while they could 
be ill spared by their commanding officers, were useless as 
nursing orderlies. 

With regard to the 3,306 partially trained men required 
to complete the establishment of R.A.M.C. with the 
expeditionary force, the advisory board recommended that 
they should be obtained partly from voluntary aid 
organizations and partly from special service sections of the 
existing R.A.M.C. militia and volunteers and volunteer 
bearer companies. But whatever system of expansion was 
adopted it was considered essential that adequate arrangements 
should be made in peace for the training, annual registration 
and periodical inspection of men whom it was proposed to 
supply on mobilization from voluntary sources. 

This was the state of affairs as regards personnel in 
1904. The Army Council, however, decided to postpone 
consideration of additions to medical establishments until 



24 MEDICAL HISTORY OF THE WAR 

the question of the final composition of an expeditionary 
force was settled. 

When, then, in 1905, the mobilization problem had been 
changed from 3 army corps and 3 cavalry brigades to an 
expeditionary force of 1 army corps of 6 divisions and 
4 cavalry brigades, the question of increase in establishments 
of the R.A.M.C. was again brought up. The requirements 
were very much the same as before, and, in March, 1905, the 
Director-General asked for an addition of some 2,000 men to 
the regular R.A.M.C. and recommended that the volunteer 
and militia companies of the R.A.M.C. and St. John 
Ambulance brigade companies should be organized and 
equipped in time of peace to enable them to mobilize as 
sections of field ambulances or of stationary hospitals, 
general hospitals and other R.A.M.C. units, and take the 
places allotted in them to partially trained men on the 
outbreak of war. 

He suggested that, to meet the shortage of regular R.A,M.C., 
there should be special enlistments of one year with the 
colours and eleven years in the reserve, and that, to meet 
the shortage in auxiliaries, men should be enlisted for 
6 months' colour service and llf years in the reserve. With 
regard to auxiliaries, it should be noted that although, at 
the time, the volunteer R.A.M.C. numbered 3, 122, the volunteer 
infantry brigade bearer -companies 2,327, and the St. John 
Ambulance brigade bearer companies 488, or a total of nearly 
6,000, it was not anticipated that a large proportion of these 
would volunteer for service abroad. But, assuming that 
40 per cent, of them would so volunteer, this would only give 
2,374 to meet the requirements of 3,306 partially trained men. 
It was the difference between these two figures which the 
Director-General suggested should be met by the new 
proposals. He counted on obtaining over 3,000 partially 
trained men amongst volunteers. But whatever numbers 
volunteered for service abroad it was important to remem- 
ber that these volunteer services, as well as men of the 
Militia R.A.M.C. companies, were depended upon and ear- 
marked for duty in the home hospitals to replace the 
regulars mobilized for service with the expeditionary force, 
and any great depletion of these by volunteering for service 
with the expeditionary force would embarrass the arrange- 
ments for carrying on the work in the home hospitals. 

After much discussion and actuarial investigation during 
1905 by the branches in the War Office concerned, a definite 
statement was eventually submitted to the Treasury in 
February, 1906, in which it was assumed that the deficiency 



PREPARATION FOR WAR 25 

would be 575 in regular R.A.M.C. and 2,100 in auxiliary 
personnel in an estimated requirement of 5,750 fully trained 
regulars and 3,324 partially trained auxiliaries. It was 
estimated that when the army reserve of the R.A.M.C. had 
grown to its full normal strength there would be about 4,850 
subordinate ranks available for mobilization and that 20 per 
cent, or 325 of the militia R.A.M.C. might be likely to 
volunteer and could be spared for service abroad. But at 
that time the regular R.A.M.C. and its reserve were 1,000 
below the normal figure, and sanction for the immediate 
increase in establishment in the estimates for 1906-7 of 
200 N.C.O.'s and men, on a 1 year's colour service and 11 years 
in the reserve, was asked for in order to build up an army 
reserve in time to meet the total deficiency. At the same 
time the Treasury was asked to sanction the enlisting of 
1,500 R.A.M.C. volunteers into the Army Reserve, in the 
same manner as members of the Army Reserve forming the 
Army Post Office and Telegraph Corps and the Railway 
Engineer Corps were dealt with, in order to build up in 
a similar manner the estimated deficiency of 2,100 of the 
partially trained personnel. 

This latter scheme was, however, abandoned, and the 
Treasury was asked to sanction instead an addition of 
250 privates to the R.A.M.C. on a 1 year's colour service. At 
first the Treasury did not give its assent to this, on the ground 
that the strength of the combatant force had not yet been 
settled and that it had yet to be ascertained whether trained 
men might not be forthcoming under the Territorial Force 
Association scheme then being evolved, to meet emergencies 
not only at home but abroad. On reconsideration, however, 
sanction was given in June, 1906, to the increase of 250 men 
in the R.A.M.G. establishments, and at the same time sanction 
was given for the formation of an Army Medical Reserve of 
Officers on the conditions outlined in the first report of the 
advisory board in 1904.* 

By the year 1906, therefore, considerable progress had been 
made in preparing the ground for placing the establishments 
of the R.A.M.C., its reserves and its auxiliary reserves on 
a much more satisfactory footing than previously in the event 
of a war in Europe. 

When the Territorial and Reserve Forces Act was passed in 
1907, the whole question of expansion of the medical services 
for war was again in the melting pot, and the position of the 
militia, volunteer and yeomanry medical services had to be 
reconsidered. Before reconstruction took place, the Army 

* Army Order 253 of November, 1906. 



26 MEDICAL HISTORY OF THE WAR 

Council, in October, 1906, had sanctioned a conference being 
held at the War Office between representatives of volunteer 
medical service officers and representatives of the St. John 
and St. Andrew's voluntary aid organizations. Schemes had 
been submitted by many of them, and also by the British 
Medical Association. The conference was held in December, 

1906, and it was generally agreed that a volunteer medical 
service should be formed as part of a territorial force to take 
the place of the regular R.A.M.C. when an expeditionary force 
went overseas. It was proposed, therefore, to form a R.A.M.C. 
for the territorial force, which should be an exact counterpart 
of the regular R.A.M.C., with corresponding ranks and appoint- 
ments, and with medical units organized for war on similar 
scales to the war establishments of the medical services of 
the expeditionary force. 

When the Territorial and Reserve Forces Act was passed, 
it was intended to provide on a territorial system a force of 
14 mounted brigades, 14 divisions and army troops ; provide 
for coast defence and supply 60 troops of cavalry for service 
with regular regiments of cavalry ; but when the estimate 
for this force was first presented to Parliament in 1907 the 
only medical details provided for were three field ambulances 
for each division, one cavalry field ambulance for each mounted 
brigade, and the medical details for regimental units and army 
troops. As there was thus no provision made for other medical 
units, the Director-General re-opened the whole subject in a 
memorandum submitted to the Secretary of State, in July, 

1907, giving details of a R.A.M.C. territorial force organiza- 
tion, similar to that of the regular R.A.M.C., to consist of the 
medical and sanitary personnel for regiments, field ambulances 
and cavalry field ambulances, stationary and general hospitals, 
sanitary units, and administrative medical staffs. The total 
personnel required for this scheme was 1,439 medical officers, 
83 quartermasters, and 17,147 other ranks.* 

To meet this establishment there was already an authorized 
establishment of R.A.M.C. militia and volunteers of 1,070 
medical officers, 29 quartermasters, and 7,782 other ranks. 
Provision had, therefore, to be made for a deficiency of 
369 medical officers, 54 quartermasters, and 9,365 other ranks, 
exclusive of 10 officers and 200 men required to form the sani- 
tary companies. In order to meet this deficiency it was pro- 
posed to reduce the peace establishment of field and cavalry 
field ambulances by 154 medical officers and 4,032 other ranks, 
and a peace establishment for the territorial force was fixed 

* Allowing for casualties and wastage, the full mobilization of the units 
required 1,531 medical officers, 91 quartermasters, and 17,979 other ranks. 



PREPARATION FOR WAR 27 

at 1,377 medical officers, 91 quartermasters, and 13,947 other 
ranks. In order to raise these numbers to a war footing of 
1,531 medical officers, 91 quartermasters, and 17,979 other 
ranks, it was proposed to enlist the agency of the St. John 
Ambulance Association in England and the St. Andrew's 
Ambulance Association in Scotland. 

Discussions and conferences on the subject of expansion of 
the medical services for war continued to take place during 
1907 and 1908 with a view to disentangling the complicated 
situation that existed in connection with the Army Medical 
Reserve of Officers, the old militia and volunteer medical 
services, voluntary aid organizations, and the new territorial 
force system. 

The situation was eventually cleared up by the formation 
out of these elements of* 

(1) A Special Reserve of Officers for the R.A.M.C. under 

conditions similar to those of the Army Reserve of 
Medical Officers. 

(2) A Special Reserve of other ranks on a militia basis and 

on a territorial force basis, supernumerary to the 
establishment of the territorial force R.A.M.C. 
units, for general service with the regular R.A.M.C. 
on the outbreak of war. 

(3) A Home Hospital Reserve composed of members of 

the St. John Ambulance Brigade in England and 
the St. Andrew's Ambulance Association in Scotland, 
for staffing the military hospitals in the United 
Kingdom upon the mobilization and withdrawal of 
the R.A.M.C. for duty in the field. 

(4) The formation of the Territorial Force R.A.M.C. on 

the lines already indicated for service in connection 
with home defence ; sanction being given for the 
appointment of an officer! to the staff of the Director- 
General for two years to assist in the arrangements 
for its organization and training. 

In 1909, when these various sources of expansion had had 
some time to develop, the Director-General reviewed the situa- 
tion as regards the requirements in R.A.M.C. personnel for the 
expeditionary force, including first reinforcements and wastage 
during the first six months, calculated as 18 per cent, for the 
field medical units and 10 per cent, for the lines of communi- 
cation units. The requirements were then estimated at 9,710 
warrant officers, non-commissioned officers and men, of whom 

* Army Order 271 of 1908. 

f Lieut. -Colonel Sir J. Clarke was appointed on the 9th October; 1908. 
His appointment terminated on the 10th October, 1910. 



28 MEDICAL HISTORY OF THE WAR 

5,955 were to be regulars or trained men and 3,755 special 
reserve or partially trained men. In addition to these, 221 
were required for various depots, medical stores, clerical and 
invaliding board duties at home, making a total requirement 
of 9,931. 

In January, 1909, in order to augment the reserve of other 
ranks of the R.A.M.C., 1,000 reservists of infantry of the line 
with less than two years to serve were asked to volunteer for 
transfer to the R.A.M.C., and come up for three months' 
special training, and, in April of the same year, another 1,000 
army reservists who had four years to serve were asked to 
volunteer for transfer to the R.A.M.G. 1,000 special reservists 
on a militia basis had also been sanctioned for medical services, 
as well as 3,000 special reservists on a territorial force basis 
to complete establishments on the outbreak of war, as partially 
trained reserves. However, only 363 of the latter class of 
special reserve had at that time been enrolled, and the Director- 
General applied, therefore, for another 1,000 army reservists 
to be transferred to the R.A.M.G., in the hope that by the 
time they had finished their training the R.A.M.G. Reserve 
would be correspondingly increased and that possibly, too, 
the special reserve of the territorial force R.A.M.G. would be 
filled up. 

This was not taken up at the time, and in a subsequent 
memorandum by the Director-General in November of the 
following year it was estimated that the shortage of trained 
men then amounted to 1,689, and of partially trained men to 
534. His proposals, however, to meet the situation by the 
transfer of another 1,000 infantry reservists to the R.A.M.C. 
Reserve were not accepted on financial grounds, and the 
Director-General, after considering material reductions in the 
proportion of trained men in the various field medical units, 
came to the conclusion that it would be possible to complete 
the mobilization of the medical services of the expeditionary 
force on the establishments for which financial sanction had 
been given, namely 4,460 regular R.A.M.C. and regular reser- 
vists, 1,500 higher trained non-regulars on a militia basis, and 
3,755 lower trained non-regulars on a territorial force basis. 

The formation of the territorial force R.A.M.C. was by this 
time well advanced, and the number of medical officers enrolled 
in regimental units was in some instances greatly in excess of 
the two sanctioned as establishment of the units. Many of 
the medical officers who were associated with the old volunteer 
regiments retained their association with them when they 
were re-constructed on a territorial force basis, and, as there 
was no limit to the number of medical officers in the old 



PREPARATION FOR WAR 29 

volunteer battalions, they became supernumerary to the estab- 
lishment of the territorial force units which took their place. 
This, however, was regarded as a satisfactory set-off against 
a failure of the special reserve of officers in the earlier years 
of its existence to attract young medical men. In fact, the 
universities and medical schools had to be visited by officers 
of the Director-General's staff during 1909 and 1910 to address 
the medical students in their final year of study and urge them 
to join the special reserve on becoming qualified. This met 
with a certain measure of response, and the special reserve of 
officers R.A.M.G. rose from 24, 34, and 92 in the years 1908, 
1909, and 1910, to 116, 142, and 191 in 1911, 1912, and 1913, 
and by the 30th June, 1914, had reached 248. 

Further assistance in organizing a reserve of medical officers 
with military training was obtained by the formation of medical 
companies of the Officers' Training Corps. This corps was 
the outcome of the proceedings of a committee under the 
chairmanship of Sir E. Ward, Permanent Under-Secretary 
for War, and was instituted for the purpose of giving students 
at schools and universities a standardized measure of military 
training with a view to their taking commissions in the regular 
army, special reserve, or territorial force. Two divisions 
were formed, a junior division at schools and a senior at 
universities. Medical units were formed in the senior division 
only and at the large universities where there were medical 
schools. A retired officer* R.A.M.G. was attached to the 
military training branch of the General Staff to arrange and 
supervise the organization and training of these units. The 
number of cadets necessary for the formation of a unit was 30, 
and if over 90 were enrolled at any medical school, a second 
unit was formed there. The basis of training was that of a 
section of a field ambulance. In this way Edinburgh, Oxford 
and Cambridge Universities in 1908, London University in 
1909, Dublin and Belfast Universities in 1910, and Aberdeen 
University in 1912, formed medical units of the Officers' 
Training Corps. Of these, London University formed four 
units and Edinburgh two, the others one unit each. The 
approximate number of cadets in training at any one 
time was 500, and the average length of training two 
and a half to three years. Altogether some 1,900 medical 
students passed through the Officers' Training Corps in 
the period between the formation of the medical units 
and the outbreak of war. The importance of this element 
in ensuring a supply of medical officers with military training 

* Lieut.-Colonel H. E. R. James. 



30 MEDICAL HISTORY OF THE WAR 

to make good deficiencies in the establishment of medical 
officers for the expeditionary force, on mobilization and after- 
wards, proved incalculable during the war. 

The formation of the Home Hospital Reserve was sanctioned 
from the 1st April, 1908, although provisional arrangements 
had been entered into in the previous year. It consisted of 
officers and other ranks. The St. John Ambulance Brigade 
undertook to provide on the outbreak of war the personnel 
required in the military hospitals in England and Ireland, 
and St. Andrew's Ambulance Association those in Scotland. 
The requirements of the home commands was at first esti- 
mated at 382 medical officers, 29 quartermasters, and 2,727 
other ranks. This establishment was sanctioned in February, 
1910, and by 1911, 2,200 men had been enrolled in the 
reserve from the St. John Ambulance Brigade and 82 from 
the St. Andrew's Ambulance Association. 

A scheme was carried out for training the Home Hospital 
Reserve of quartermasters and non-commissioned officers in 
military hospitals for eight days every two years, and more 
detailed tables were subsequently prepared showing the 
requirements of each command. The estimate then was 
that 392 medical officers and 2,632 other ranks would have to 
be obtained from the St. John Ambulance Brigade and 19 
officers and 95 other ranks from the St. Andrew's Ambulance 
Association. On mobilization, all of the personnel would 
receive corresponding rank in the R.A.M.C., officers being 
commissioned and other ranks being enlisted into it with per- 
mission to wear the uniform of their voluntary aid organization. 
This reserve was, therefore, considered adequate for the 
purpose of replacing the regular R.A.M.C. personnel in home 
hospitals on mobilization. 

As regards the territorial force R.A.M.C., there was no lack 
of medical officers and personnel for the field medical units. 
Twenty-three territorial force general hospitals, staffed by local 
medical men, who received commissions ine th R.A.M.C., T.F., 
were being planned in localities in touch with medical 
schools, and the necessary contracts were being entered into 
to take over buildings and equip them on mobilization. But 
it was pointed out by the directorate of military operations 
that provision had only been made for regimental and field 
ambulance personnel with divisions and for general hospitals 
on lines of communication, and that no units had been pro- 
vided to correspond with the clearing hospital, ambulance 
trains and stationary hospitals of the expeditionary force. 
In the event of invasion the field medical units would conse- 
quently be clogged with wounded, and there would be great 



PREPARATION FOR WAR 31 

confusion and difficulty in freeing the fighting forces of the 
masses of wounded collected after battle. 

The Director-General was not in a position at the time to 
apply for any addition to the estimates for medical services of 
the territorial force to meet this obvious defect in the organiza- 
tion of the medical services of the territorial force, and he applied 
to the medical section of the directorate of military operations 
to suggest a scheme by which these gaps in the collection and 
evacuation of wounded in the event of invasion might be filled. 
A scheme was consequently submitted for meeting the require- 
ments by organizing and utilizing voluntary aid in the form 
of voluntary aid detachments, similar to the organization of 
voluntary aid detachments in Japan and other countries. They 
were to undertake the duties of forming clearing hospitals and 
collecting wounded through them from field ambulances to 
railhead ; of taking care of the wounded during transport by 
train to the general hospitals, and of establishing rest and 
refreshment stations at halting places along the line of railway 
and auxiliary hospitals throughout the country for the recep- 
tion of those unfit for further transport. Men's detachments 
were suggested for the duties of collection and transport, and 
women's detachments for those of rest stations and auxiliary 
hospitals. This was the origin of the voluntary aid detach- 
ment movement throughout the United Kingdom. The scheme 
was issued by the Secretary of State for War on the 16th 
August, 1909, to the secretaries of territorial force county 
associations, who were asked to make use of the existing 
organization of the British Red Cross Society and the St. John 
and St. Andrew's Ambulance Associations for the formation 
of unlimited numbers of men's and women's voluntary aid 
detachments, the composition and duties of which were defined. 

The movement met with enthusiastic response in every 
county of England and Scotland, and by the beginning of 1914 
as many as 519 men's and 1,757 women's voluntary aid 
detachments had been registered at the War Office. Unfortu- 
nately there was an unhappy and apparently an insurmountable 
misunderstanding in some counties with regard to the raising 
and registering of voluntary aid detachments. In the scheme 
sanctioned by the Secretary of State the detachments were 
to be raised through the territorial force associations by the 
British Red Gross Society, but only persons who had obtained 
the St. John Ambulance Association or St. Andrew's Ambulance 
Association certificates could be enrolled in them. County 
directors of voluntary aid were appointed by the British Red 
Cross Society to raise the detachments and generally act as 
their medium of communication with the territorial force 



32 MEDICAL HISTORY OF THE WAR 

county associations. This arrangement worked well at first, 
but as the movement became more extensive and popular 
complaints were made by various individuals of their inability 
to enrol without going to the expense of attending a course of 
lectures for the St. John Ambulance Association certificates, 
while other educational bodies complained because their 
ambulance certificates were not accepted by the British Red 
Cross Society as qualifying for enrolment in its voluntary aid 
detachments. It was consequently decided that other ambul- 
ance certificates than those of the St. John Ambulance Associa- 
tion should be a qualifying certificate ; but, as this altered 
the arrangement, by which, while the Red Cross Society alone 
was empowered to raise voluntary aid detachments, the order 
of St. John had the exclusive right of qualifying members for 
enrolment in them, it was decided not to restrict the power of 
raising voluntary aid detachments to the British Red Cross 
Society's organization, but to extend the power to the St. John 
Ambulance and the St. Andrew's Ambulance Associations as 
compensation for the loss of the exclusive right of giving the 
qualifying certificate. 

As both these associations as well as the British Red Cross 
Society had their county organization, the county interests of 
the Red Cross Society and St. John Ambulance Association 
came in conflict with one another. The situation, in fact, 
became so acute that in the summer of 1914 a committee was 
formed at the War Office under the chairmanship of Sir Walter 
Lawrence "to enquire into and report on the difficulties which 
had been experienced in co-ordinating the work of the societies 
and associations in forming, registering, training, administering 
and controlling voluntary aid detachments, and to make sugges- 
tions for amending existing schemes for the organization of 
voluntary aid detachments with a view to the removal of such 
difficulties." The War Office, Territorial Force, Order of 
St. John, the British Red Cross Society, and the St. Andrew's 
Ambulance Association were represented on the committee. 
It met for the first time on 3rd July, 1914, but after the fifth 
meeting war had been declared and the work of the committee 
for the time being was abandoned. 

The evidence, so far as it went, emphasized the difficulties of 
a county organization by which the Red Cross Society, the Order 
of St. John, and the Territorial Force County Association might 
each raise voluntary aid detachments. The territorial force 
county association was responsible to the War Office and was 
the medium of communication with the War Office in connection 
with voluntary aid detachments. It might delegate its power 
of raising detachments to the other bodies or raise them itself. 



PREPARATION FOR WAR 33 

Consequently, when the power was delegated in a county to the 
Red Cross Society, difficulties were put in the way of the 
St. John Ambulance Association registering detachments from 
its own members in that county ; and, on the other hand, the 
Red Cross Society had similar difficulties in a county where the 
St. John Ambulance Association was predominant and had 
its own county director. There was strong evidence of the 
need of a central committee to control organizations for volun- 
tary aid in war on which all interests concerned, including 
the War Office, should be represented. Although Sir Walter 
Lawrence's committee ceased to carry on its enquiry and 
submitted no report after the outbreak of war, further friction 
between the British Red Cross Society and Order of St. John 
was avoided by the formation of a joint committee of the 
two bodies during the war. 

Great Britain had been for years notoriously backward 
in realizing the necessity of organizing voluntary aid for war 
and co-ordinating it, under War Office control, with the require- 
ments of the medical services. The popular mind had for long 
been under the impression that voluntary aid, untramelled 
by official control, would be the best, most prompt and readiest 
means of succouring wounded on the battlefield, and even in 
the year 1914 popular demonstrations of voluntary aid detach- 
ment work arranged by the British Red Cross Society only 
encouraged this impression. The Geneva Convention of 1906 
for the first time recognized and defined the position and 
activities of voluntary aid societies in the field. The emblem 
and expression " Red Cross " were rigidly restricted to the 
official medical services of armies, and societies were only 
permitted to use the emblem and term if duly recognized by 
their Government as forming an integral part of the medical 
services in war. But with the exception of the co-ordinating 
control of voluntary aid exercised between the years 1899 and 
1904 by the Central British Red Cross Committee at the War 
Office, the tendency of voluntary aid organizations both before 
and afterwards was to keep clear of association with the War 
Office. The fallacy and disadvantages of this conception were 
apparent immediately war was declared. It is true that the 
territorial force county associations acted as the local con- 
trollers of voluntary aid schemes, but there was no co-ordinating 
authority associated with the War Office* through which the 
local branches of the Red Cross Society and Ambulance 
Associations might be guided in their activities for organizing 

* There was a Technical Reserve Advisory Committee on Voluntary Aid 
at the War Office, on which various voluntary aid organizations were repre- 
sented. It was constituted apparently to deal only with questions of reserves 
of personnel for medical services. 

(1735) D 



34 MEDICAL HISTORY OF THE WAR 

and training their members to supplement the official medical 
services in time of war. 

With all these resources more or less definitely organized to 
provide the regular Army Medical Service with powers of 
expansion in the event of war in Europe, the lesson of the South 
African War, as enunciated by the Royal Commission in 1903, 
had been well learnt and practised by the year 1914. 

But in preparing for war the importance of expanding the 
nursing service was not forgotten. Queen Alexandra's Imperial 
Military Nursing Service was inaugurated in 1902. Its organiza- 
tion embodied the recommendations of the committee which 
had been appointed in 1901 to consider the re-organization of 
the military nursing service. Previously there was an army 
nursing service of 88 lady nurses, supplemented by an army 
nursing service reserve, initiated by H.R.H. Princess Christian 
in 1896 and officially recognized and constituted in Army 
Orders of March, 1897. This reserve played an important part 
in the military nursing service both during and after the South 
African War. 805 of its members served in South Africa during 
that war, 33 at various other stations abroad, and 538 at home 
stations on various occasions. The reserve was controlled by 
a committee at the W T ar Office. After the South African War 
and when Queen Alexandra's Imperial Military Nursing Service 
was constituted, many stories were spread, reflecting on the 
conduct of nurses of this reserve. They were without founda- 
tion but caused much trouble and unhappiness to its members. 
They originated in the fact that during the South African War 
a number of ladies and others were appointed locally to the 
nursing service in South Africa without reference to the Com- 
mittee of the Army Nursing Service Reserve and without 
examination into their qualifications. Instances of incom- 
petence amongst some of these irregularly appointed nurses were 
wrongly attributed to the Army Nursing Service Reserve, and 
in 1903 a question arose as to whether this reserve should still 
be officially recognized. Its continued existence was, however, 
definitely approved on the conditions under which it had been 
officially recognized in 1897. It was to be directly under the 
War Office, have no official connection with the Q.A.I. M.N.S., 
and be outside the control of the Nursing Board. The 
Q.A.I. M.N.S., on the other hand, reserved to itself the sole 
and absolute right both in peace and war of appointing 
nurses for service in military hospitals, but in the event 
of war would, in selecting nurses, give first consideration 
to the Army Nursing Service Reserve and appoint members 
of that service who fulfilled the requirements of the Nursing 
Board. 



PREPARATION FOR WAR 35 

The Army Nursing Service Reserve nurses continued to be 
employed in military hospitals at home and abroad until 1910, 
when a Q.A.I. M.N.S. Reserve was established. In 1913 the 
strength of the Army Nursing Service Reserve was 469, and it 
was then considered how far the nurses on its books could be 
utilized in time of war, in view of the fact that the Q.A.I. M.N.S. 
had by that time formed its own reserve. This resulted in a 
classification of the existing members into three classes, namely 
those approved by the Nursing Board as suitable for employ- 
ment, those suitable to supplement the first class should their 
services be required, and those found unsuitable. In this way 
the reserve was for all practicable purposes gradually absorbed 
into the Q.A.I. M.N.S. Reserve, and the last meeting of its com- 
mittee of which there is any record was in January, 1913, 
although in September, 1914, there were 337 names on its roll. 

The Q.A.I. M.N.S., when it was formed in 1902, had an 
establishment of 112, which was increased in subsequent years 
to over 290 before the outbreak of war. Its reserves were 
then drawn from the Army Nursing Service Reserve, the 
Q.A.I. M.N.S. Reserve, and a civil hospital reserve formed in 
1911 to supplement, from the civil hospitals in the country, the 
nursing services in the military hospitals of peace garrisons on 
the outbreak of war. The number of this last reserve was 
800 in 1914. 

The scheme for the organization of the Army Nursing Service 
was based upon the provision of a matron and eight nursing 
sisters or staff nurses for every 100 beds in military hospitals 
having that number of beds or more. The establishment 
originally sanctioned on this scale in 1901 was 230, and until 
this establishment was obtained members of the Army Nursing 
Service Reserve continued to be employed in military hospitals 
both at home and abroad. The original establishment of 
230 for the Q.A.I. M.N.S. was increased year by year, a general 
sanction having been given for an establishment of 382 without 
special authority and a maximum of 411 with special authority. 
As the numbers increased so the number of Army Nursing 
Reserve who were employed in military hospitals decreased. 

A Territorial Force Nursing Service was also organized, with 
its own Matron-in-Chief* and its own Nursing Board, for the 
purpose of staffing the 23 territorial force general hospitals. 
The principle on which this nursing service was organized was 
similar to that of the medical staff of the territorial force 
general hospitals. The members enrolled in it were matrons 
and nursing staff of the large civil hospitals connected with the 

* Miss S. Browne, after vacating the appointment of Matron-in-Chief of 
the Q.A.I.M.N.S. in 1906. 

(1735) D2 



36 MEDICAL HISTORY OF THE WAR 

medical schools of the localities where the general hospitals 
were to be established. A Territorial Force Nursing Service 
Reserve was also formed by enrolling reserve nurses in each 
of the general hospital centres. There were thus 23 centres and, 
in each, 31 members of the T.F.N.S. Reserve had been enrolled, 
or 713 in all when war was declared. In addition, 402 had been 
enrolled in the reserve at the headquarters of the T.F. Nursing 
Service at the War Office for general service. The T.F.N.S. 
had an establishment of 112 members in each T.F. general 
hospital and so had a strength of 2,576, exclusive of its 
reserve, ready for mobilization when war broke out. 

The trained personnel for nursing services was still further 
increased by enrolling in the Q.A.I.M.N.S. a nursing section 
of men of the R.A.M.C. who were specially trained by the 
Q.A.I.M.N.S. nursing sisters, matrons and medical officers, had 
gone through a period of probation, were successful in examina- 
tions for a certificate in nursing, had completed three years 
training, and were in other respects suitable. Men of the 
R.A.M.C. were also eligible for special training as masseurs and 
as attendants in operating rooms and in skiagraphy and 
electro- therapeutics. 

All these changes in army medical personnel, made with 
the object of providing an adequate reserve to the Army Medical 
Service in time of war, brought medical men, nurses, and others 
engaged in civil pursuits in much closer touch than formerly 
with the regular R.A.M.C., with its requirements and with 
military conditions generally. Their influence on the efficiency 
of the arrangements for the care of the sick and wounded 
cannot be emphasized too much. But a conglomeration of 
medical units and a personnel in numbers sufficient to staff 
them would still constitute a mass of elements lacking cohesion 
and floundering in ignorance of the measures which should be 
taken to carry out their duties, had no arrangements been 
made for their training. Nor could proper use be made of 
them unless the staff of the army and officers commanding 
formations and units were given training in the organization 
and requirements of the medical services. 

The period between the South African War and the European 
War was, fortunately, a period in which marked advances in 
this respect took place. Important changes were effected not 
only in the professional education of the regular medical 
officer, but also in the graduated training of officers and men 
of the R.A.M.C. in their administrative and military duties 
in the field, and of staff officers and other branches of the army 
in the administrative and sanitary requirements of the medical 
services 



PREPARATION FOR WAR 37 

The first important change was the uprooting of the 
army medical school from Netley, where it was con- 
sidered to be out of touch with the progressive thought 
and practice of surgery and medicine in the great medical 
schools, and transferring it to London in the form of a 
Medical Staff College.* 

Treasury sanction was obtained in June, 1902, for preliminary 
steps being taken ; provision was made in the estimates for 
the year 1903, and the erection of the present Royal Army 
Medical College at Millbank was commenced. Pending its 
erection temporary premises, at first in the Hotel Belgravia 
in Victoria Street, and afterwards in the St. Ermin's Hotel, 
were occupied as an R.A.M.C. mess during the courses of 
instruction of captains for promotion and the lieutenants 
R.A.M.C. on probation. The laboratories of the Royal 
College of Physicians and Surgeons on the Embankment were 
hired for their technical training in military hygiene and 
pathology. The senate of the Army Medical School was 
abolished and the control of studies at the Medical Staff 
College in London was taken over by the advisory board for 
medical services at the War Office, with a college council of 
the professorial and teaching staff, under the commandant. 
A board of studies was constituted consisting of the Director- 
General or his deputy as president, the commandant of the 
college, and one military and one civilian member of the 
advisory board, together with the professors of military 
hygiene and pathology and an officer of the Indian Medical 
Service, nominated by the India Office, as members. 

The permanent buildings were opened in 1906, and in 1907 
the Queen Alexandra's Military Hospital at Millbank and the 
Medical Staff College, now called the Royal Army Medical 
College, were combined under the one administrative control 
of the commandant of the college. Senior as well as junior 
courses of instruction were organized, the former for captains 
who were required to pass an examination in professional 
subjects previous to promotion to major's rank, and the latter, 
as before, for lieutenants on probation. The senior course 
was for six months, extended in 1912 to nine months. It 
became one of the most thorough and important post-graduate 
courses for the medical profession in the United Kingdom 
The educational resources of the London medical schools were 

* The question was taken up by the Secretary of State in 1901 on the recom- 
mendation of Mr. Brodrick's Committee on the reorganization of the Army 
Medical Service, and the opinion of the advisory board on medical services 
was sought. The advisory board strongly supported the recommendations 
and submitted sketch plans for the site of a mess building and laboratories 
at Millbank. 



38 MEDICAL HISTORY OF THE WAR 

at its disposal, while the technical training in military hygiene 
and pathology was carried out in the college itself. It was 
recognized as one of the medical schools of the University of 
London in October, 1908 ; as a teaching institute, as regards 
pathology, for the degree of Bachelor of Medicine of the 
University of Cambridge in 1910, and for instruction in opera- 
tive surgery for the diploma of Fellow of the Royal College of 
Surgeons. The association of officers of the Royal Army 
Medical College with the members of the civil medical profession, 
an association which proved of far-reaching importance during 
the war, was thus cemented still more closely. 

The Inspector-General of the Forces, in reporting on an 
inspection of the R.A.M.C. establishments at Aldershot in 
1908, remarked that " in order to ensure the smooth working 
of medical services in the field it is necessary that medical 
officers should be trained in peace time, be practised in adapting 
their arrangements to military situations based on definite 
schemes, and it is no less necessary that staff officers should 
become fully acquainted with the possibilities and limitations 
of the authorized medical organization." He suggested that 
to further this end instruction in the principles of staff duties 
in the field should be given at the Royal Army Medical College. 
A War Office committee was consequently appointed, under 
the chairmanship of Colonel Kiggell, Assistant Director of 
Staff Duties, to consider and submit recommendations 
on the general scope of the instruction to be given 
in lectures at the R.A.M. College ; and of the instruction in 
field duties to be carried out in commands. The proposals 
included lectures by the A.G.'s, Q.M.G.'s, and general staff ; 
the attendance of medical officers at war games, staff rides and 
special staff rides for medical services ; and a syllabus of training 
for field medical units and the medical units of the Officers' 
Training Corps. The committee pointed out that the work 
of R.A.M.C. officers involved such military subjects as the 
professional supervision of sanitary measures, the collection 
of sick and wounded, the compilation of records regarding 
them, arrangements for their transportation from the front, 
the discipline and maintenance of combatants under their 
care, the replenishment of medical and surgical supplies, the 
provision of food, clothing and other requirements of their 
men ; the care and management of transport allotted to them, 
arranging their camps and movements and fitting their units 
into their allotted place on the line of march, and generally 
exercising the same functions as officers of other units with 
the sole exception of actual combatant work. Further, while 
officers of the R.A.M.C. are not charged with combatant duties, 



39 

they are intimately concerned in the combatant work of other 
branches, and the efficient performance of their duties on the 
battlefield demanded some knowledge of tactics and the 
general principles on which military operations are conducted ; 
.they must also be capable of understanding from an operation 
order what is likely to be required of them and be capable of 
issuing orders in accordance with the field service regulations 
governing them. The committee, keeping in view these 
general principles, submitted an exhaustive review of the scope 
of the training which should be given to the Royal Army 
Medical Corps officers, together with a syllabus of graduated 
training of medical units and all ranks of the R.A.M.C. in camps 
of instruction, including the training to be given to the medical 
units of the territorial force in their annual training camps. 
Instructions were consequently issued by the Army Council 
to all commands at home and abroad in April, 1908, drawing 
attention to the importance of practising medical officers in 
adapting their arrangements to military requirements, and also 
of staff officers becoming fully acquainted with the possibilities 
and limitations of the authorized medical organization. Com- 
manders-in-Chief were asked to arrange staff tours to instruct 
medical officers, especially in such subjects as map reading 
and the general principles of tactics, strategy, and administra- 
tion. The syllabus for the graduated training of the medical 
units and personnel of the R.A.M.C. was added as a special 
chapter on Field Training to the Manual of Training of the 
R.A.M.C. 

The general outlook of medical officers on the subject of field 
medical organization and training for a war of magnitude in 
Europe was further widened by the publication of handbooks, 
compiled in the medical section of the directorate of military 
operations, on the history and organization for peace and war 
of the medical services of the armies of France, Germany, 
Italy, Russia, Austria-Hungary, Belgium, and the Nether- 
lands. Under the same influence medical manoeuvres were 
for the first time sanctioned and a scheme prepared, based on 
a report by the officer in charge of the medical section of the 
military operations branch on medical manoeuvres at which 
he had been present in France. The first of the manoeuvres 
of this kind took place in the Salisbury Plain area in 1910, and 
similar manoeuvres were held in India in the winter of 1912-13 
in the Northern Command at Rawalpindi, and of 1913-14 in 
the Southern Command at Poona. 

The general system of training medical services was extended 
by the Imperial General Staff to the medical services of over- 
seas dominions, and some of their medical officers, notably 



40 MEDICAL HISTORY OF THE WAR 

from Canada, went through courses of instruction in England. 
Thus when war was declared in 1914 there was a more or less 
uniform system of training for the regular R.A.M.C., for the 
R.A.M.C. special reserve, the territorial force R.A.M.C. and 
Officers Training Corps, for the military medical services in 
India, and for the medical services of overseas dominions. 

As regards the training of staff officers in the organization 
and requirements of the medical services, the importance of 
the subject was forcibly impressed upon the War Office in con- 
nection with a staff ride held by the Director of Staff Duties 
in May, 1907.* During the progress of the exercise it was 
evident that the field medical organization which had been 
introduced after the South African War, with such new units 
as field ambulances, cavalry field ambulances, clearing hospitals, 
sanitary sections and sanitary squads, was not understood by 
the officers taking part in the staff ride, and this led to a desire 
to have special instruction on the subject by means of lectures 
at the Staff College. The first of these lectures was given in 
December, 1907. It enunciated the principles of field medical 
organization, the zones of collecting, evacuating and dis- 
tributing casualties, the linking together of the medical units 
in the different zones, details regarding the organization and 
employment of the regimental medical service and of the 
various medical units ; the influence of modern advances 
in medical and surgical science and of the Geneva Convention 
on the problems of dealing with casualties in the field ; 
the quantity and classification of sick and wounded; the 
nature, amount and use of different forms of ambulance 
transport material, and of special units for removal of 
wounded ; the calculation of the time required to collect 
and evacuate wounded, and various problems connected with 
the handling and disposal of medical units in different military 
situations ; considerations, in other words, which constitute 
the strategical and tactical employment of medical services, 
a subject which had scarcely received recognition or been 
formulated, in connection with the British Army until then. 
The lecture was printed and issued by the general staff to 
commands and units and was followed by a similar lecture at 
the Cavalry School, Netheravon, in September, 1908, dealing 
with those special points which affect the work of medical 
services during cavalry operations in the fieldf. Lectureships 
on Medical Services were subsequently established at the Staff 

* See Journal of the R.A.M.C., vol. ix, p. 350, for medical report on this 
staff ride. 

t The lectures were given by Lieut.-Colonel W. G. Macpherson and were 
published in the Journal of the R.A.M.C., vol. xii, pp. 78 and 197. 



PREPARATION FOR WAR 



41 



College in Camberley and Quetta,* and the principles enunciated 
in these lectures embodied in Field Service Regulations, Part II, 
issued in 1909, and in the R.A.M.C. Training Manual, issued 
in 1911. 

The changes which were thus effected in the period between 
the South African War and the War in Europe in adminis- 
tration, field organization, personnel, and power of expansion, 
in professional education and staff training, placed the 
medical and sanitary services in an infinitely better state of 
preparation than they had ever been in any previous period ; 
and to this fact must be attributed, in a large measure, the 
exceptional freedom from adverse criticism with which they 
stood the test of war. 



* Lieut. -Colonel M. W. Russell became lecturer at the Staff College, 
Camberley, and Colonel W. G. Macpherson lecturer at the Staff College, Quetta, 
in addition t i their other duties. 



CHAPTER III 

MOBILIZATION OF THE MEDICAL SERVICES 

IN the event of war mobilization was so arranged that 
the medical services of the expeditionary force, of the 
territorial force and of home and colonial defences, as well as 
certain organized elements of voluntary aid, would take up their 
appointed places automatically. None of the medical units of 
the expeditionary force, however, existed as such in time of 
peace, and in this respect their mobilization differed from that 
of other units of the force. But the mobilization scheme 
provided for bringing the personnel, transport and equipment 
of the R.A.M.C. units together at definite places of assembly 
on the outbreak of war. 

The preparations for this, which grew up in the years imme- 
diately preceding, bore ample fruit when mobilization orders 
were issued on the 4th August, 1914. The details of mobiliza- 
tion were known to all officers of the army medical service 
through the " Mobilization Instructions, Army Medical Service " 
and " Field Service Manual, Army Medical Service (Expedi- 
tionary Force) " issued in time of peace.* Each officer and man 
was in possession of a document or card containing precise 
instructions as to which unit or appointment he would join. 
Consequently, when the expeditionary force mobilized for 
active service overseas, the whole personnel of the army 
medical service required for its medical units went at once 
to their places of assembly, where medical comfort panniers, 
ordnance equipment, transport vehicles, horses and drivers, 
were also collected. There was practically no hitch and, with 
the exception of the ambulance trains, the details of mobiliza- 
tion worked out on the whole smoothly and well, although 
one or two practical points, such as the arrival of riding and 
draught horses at the place of assembly of a medical unit 
in advance of their picketing gear or of their drivers and atten- 
dants.f caused some temporary embarrassment in a few cases. 
The late arrival of non-commissioned officers also occasionally 
created difficulties, but these were difficulties which only 
stimulated the initiative of commanding officers and were 
readily overcome. 

* The latest edition had been published in 1914. 

f Drivers and horse attendants belonged to the Army Service Corps, and 
were attached to medical units. 

42 



MOBILIZATION 43 

The medical units which thus mobilized in August imme- 
diately after the declaration of war were five cavalry field 
ambulances, twenty field ambulances, six clearing, twelve 
stationary and twelve general hospitals, one convalescent depot, 
the personnel of six ambulance trains, three hospital ships, 
three advanced and three base depots of medical stores, two 
sanitary sections and eleven sanitary squads*. 

The R.A.M.C. and nursing personnel required for each of 
these units was as follows : 

Unit. Officers. Other Ranks. Q.A.I.M.N.S. 

Cavalry Field Ambulance .. 6 .. 118 .. 

Field Ambulance .. . . 10f .. 224 .. 

Clearing Hospital . . . . 8f . . 77 . . 

Stationary Hospital . . . . 8f . . 86 . . 

General Hospital .. . . 21f .. 143 .. 43 

Convalescent Depot . . . . 3f . . 3 . . 

Ambulance Train . . . . 2 . . 45 . . 

Hospital Ship .. ..4 .. 28 .. 4 

Advanced Depot Medical 1 . . 5 

Stores 

Base Depot Medical Stores . . 2f . . 8 . . 

Sanitary Section . . . . 1 . . 25 . . 

Sanitary Squad . . . . . . 5 . . 

Officers and other ranks of the R.A.M.C. had also to mobilize 
with regimental units of other branches of the service. Their 
medical equipment was already kept in the mobilization store 
of the unit concerned, or stored in the military hospital at its 
place of mobilization or in other conveniently placed stores. 
Each infantry battalion had attached to it on mobilization 
one officer and five men of the R.A.M.C. ; a field artillery 
brigade, a divisional train and a divisional ammunition column, 
one officer and three men ; a cavalry regiment and brigade 
of horse artillery, one officer and two men ; and there were 
smaller units with a proportionate number of men of the 
R.A.M.C.J 

Consequently 15 cavalry regiments, 2 horse artillery and 
24 field artillery brigades, 78 infantry battalions, 6 divisional 
trains and 6 divisional ammunition columns, signal and field 
companies of the Royal Engineers, and minor units of army 
troops and lines of communication had to be provided with 
their attached medical personnel on mobilization. 

* See Appendix A. f These figures include one quartermaster. 

J The men of the R.A.M.C. were nominally attached to units for water 
duties ; but they became in fact trained R.A.M.C. orderlies under the medical 
officer for general medical work, especially during battle. 

This R.A.M.C. personnel had all been told off to their units by mobiliza- 
tion cards previous to the declaration of war. 



44 MEDICAL HISTORY OF THE WAR 

In addition to these, administrative and executive medical 
officers and men were detailed for General Headquarters, for 
the headquarters of divisional formations, for the headquarters 
of the lines of communication, for each of the three bases of 
disembarkation of the expeditionary force and for an advanced 
base. The total requirements of the expeditionary force in 
accordance with this scale of R.A.M.C. personnel for regimental 
and medical units and headquarters of formations were esti- 
mated to be about 800 medical officers, 56 quartermasters, 
and 9,000 other ranks, together with 528 members of the 
Q.A.I.M.N.S. 

The number of officers, nursing sisters and men on the active 
list in the United Kingdom was, however, very much short of 
these numbers when war was declared. On the 31st July, 1914, 
the total number of regular officers of the Army Medical 
Service on the active list was 1,048, and of quartermasters 42 ; 
while that of other ranks was 3,797 ; but, of these, 333 officers 
were on the Indian establishment and 229 officers and approxi- 
mately 1,300 other ranks at other stations abroad. 83 officers 
were also required for the War Office and home appointments 
in accordance with the general scheme of mobilization, so that 
only 406 regular R.A.M.C. officers were immediately available 
for mobilization with the expenitionary force. There were, 
however, on the reserve of officers, that is to say, on the retired 
list and liable to be recalled for service, 119 officers* and 
10 quartermasters of the R.A.M.C. ; and there were also 
248 officers enrolled in the R.A.M.C. special reserve, while the 
regular reserve of other ranks numbered 4,937 and the special 
reserve 1,435. 

It was known that neither the reserve of officers nor the 
special reserve would be sufficient to complete the mobilization 
of the medical services of the expeditionary force, but it had 
been anticipated that many civil medical practitioners would 
offer themselves for service in the event of war. In fact, the 
" Field Service Manual " provided for a definite proportion of 
the officers of the various medical units, amounting in all to 
between 45 and 50 per cent.,t to be obtained from the civil 
medical profession or special reserve. 

Reliance was placed on obtaining the number of qualified 

* Nineteen of these, as well as 38 not liable to be recalled to service, were 
already employed, mostly in charge of small military hospitals at depots in 
the United Kingdom. 

f The number of civil surgeons allowed in war establishments for 1914 
was two in a cavalry field ambulance, three in a field ambulance, four in 
a clearing and stationary hospital, fourteen in a general hospital, and one 
in a convalescent depot and ambulance train ; or a total of 381 with the 
expeditionary force. 



MOBILIZATION 45 

medical men, who might be required to complete the war 
establishments on mobilization, by advertisements in the press. 
This was, indeed, one of the pre-arranged features in the mobili- 
zation of the medical services and immediately war was declared 
the advertisements appeared. Civil medical practitioners 
responded in large numbers. Those selected were commissioned 
as temporary lieutenants in the R. A.M. C. Their contract with 
the War Office was for twelve months or until their services 
were no longer required. They were granted pay of twenty-four 
shillings daily, inclusive of all allowances except travelling 
allowance, and an outfit allowance of 30 and a gratuity of 
60 on the termination of their engagement. 

The required number of quartermasters was obtained by 
promotions from the ranks ; and a deficiency of some 800 in 
the other ranks of the R.A.M.C. after the reserve and special 
reserve had been called up* was made good by the enlistment 
in the R.A.M.C. of men who in civil life had been employed as 
sick attendants, male nurses, cooks, and dispensers, as these 
employments avoided the necessity of training them for such 
special duties. 

The Q.A.I.M.N.S. had a strength of 290 on the active list and 
173 in its enrolled reserve at the beginning of August, 1914 ; 
but Princess Christian's Army Nursing Service Reserve con- 
tinued to have a large number of nursing sisters on its books, 
and the civil hospital reserve was also available for replacing 
the Q.A.I.M.N.S. in the home hospitals. The requirements 
of the expeditionary force medical units, as regards nursing 
services, were met from these sources. 

The expeditionary force by these means of expansion mobi 
lized complete as regards medical personnel. Its medical 
units were also complete in medical, ordnance and other supplies 
and transport by the time they were required to proceed over- 
seas, with the one exception of the six ambulance trains, 
equipment for which was not complete when war was declared 
nor did their equipment mobilize with the personnel and 
proceed to France. The trains were to be assembled in France, 
each consisting of 33 special goods trucks, with brake vans for 
stores, office and dispensary, a restaurant car or van fitted as 
a kitchen, and first and second-class coaches for the personnel. 
Each truck was to be fitted with four stretcher frames of the 
Brechot-Desprez-Ameline type used in the French Army, 
carrying three stretchers each. 

* It is worthy of record that of the 6,000 and more reservists of all classes 
called up, only 17 failed to appear. The absentees were probably men who 
had died or being in some distant part of the world did not receive their 
mobilization notices in time. 



46 MEDICAL HISTORY OF THE WAR 

For the six ambulance trains, therefore, 792 stretcher frames 
and 2,376 field stretchers were required. It was intended that 
they should be handed over to the personnel at the place of 
assembly of the trains in France. Not only, however, was the 
number of stretchers deficient, but other ordnance stores, such 
as ward utensils, were not available at the place of assembly of 
the trains. The declaration of war, consequently, found the 
medical services incomplete as regards equipment for its 
ambulance trains ; and for a time a situation was created which 
threatened a serious breakdown in the arrangements for the 
evacuation of sick and wounded and gave rise to many 
complaints.* 

The ambulance trains were, in fact, the one blot in the mobiliza- 
tion of the medical units, and their failure to mobilize complete 
with full equipment exemplified a lesson which had been learnt 
at the time of the first Egyptian Campaign in 1882, namely, 
the importance of medical units mobilizing and moving to their 
destinations complete in every respect. The lesson had been 
well learnt as regards the other medical units. Their equipment 
no longer went overseas without their personnel or their per- 
sonnel without their equipment. It was not, of course, expected 
that locomotives or rolling stock of ambulance trains could be 
mobilized otherwise than as arranged for in France or in other 
theatres of war ; but the maintenance of the fittings for the 
trains and equipment for them in mobilization stores in the 

* According to the diary of the D.D.G., A.M.S., at the War Office, it would 
appear that the immediate completion of the contract for 1,100 stretchers, 
for the supply of 2,000 more, and for authority to purchase ordnance stores 
for the six ambulance trains was urged on the 31st July, 1914, in anticipation 
of war being declared. As there was still doubt about the possibility of having 
them ready in time, on the 10th August, 1914, it was proposed to use the 
stretchers of the clearing hospitals for the trains and replace them in the clear- 
ing hospitals by cots. In fact, the D.M.S. wrote from France to the D.G., 
A. M.S., on the 20th August, saying : " deficiency of stretchers for fitting out 
ambulance trains is causing great inconvenience. I shall be compelled to rob 
clearing hospitals." In a later letter, dated the 9th September, 1914, the D.M.S. 
further reported that complete ordnance equipment, such as ward utensils, 
was not available and an officer was sent to Paris to purchase articles there. 
Until February, 1914, experiments had been going on to determine the fittings 
of the six ambulance trains for overseas ; and as a result of these experiments 
792 stretcher frames were entered for the first time in the War Reserve 
Schedule reprinted in June, 1914. Provision was also made for 1, 100 stretchers 
to be added to the stock of stretchers in war reserve during 1914-15 ; and 
a contract for the supply of these was made for delivery at the rate of 70 per 
week commencing on the 3rd July, 1914, and terminating on the 18th October. 
When war was declared further orders were at once placed, and 930 stretchers 
were sent to France in August and 5,019 in September, 1914. The number of 
stretchers eventually supplied reached a very high figure. The fact that it was 
only in February, 1914, that the fittings of the ambulance trains were definitely 
decided upon and that provision was made for only 1,100 stretchers in the 
estimates of 1914-15 out of the total required appear to have been the factors 
which prevented the equipment of the trains being ready when war was 
declared. 



MOBILIZATION 47 

United Kingdom and the embarkation of personnel and 
equipment together, as was done later on when ambulance 
train units were despatched to Macedonia were just as im- 
portant in the case of ambulance trains as in the case of other 
medical units. 

In the plan of medical organization for war it was contem- 
plated that one sanitary section would be required for each 
base. As there were three bases, where troops disembarked, 
as well as an advanced base, the two sanitary sections mobilized 
would appear to have been insufficient. It was no doubt 
intended to make good this deficiency by utilizing the sanitary 
squads, which in themselves were equivalent to two sanitary 
sections, although nominally intended for detached work at en- 
training and detraining stations on the lines of communication. 

But whatever other defects in the scale of units or their 
equipment may have been brought to light at a later period 
after the expeditionary force embarked for France, the mobiliz- 
ation of medical services so far as the scheme of mobilization 
was concerned may be said to have been successfully and 
expeditiously carried out. 

Surgeon-General T. P. Woodhouse was appointed director 
of medical services of the expeditionary force. He mobilized 
with General Headquarters in London from the appointment 
of D.D.M.S., Aldershot, and proceeded to France on the 9th 
August, 1914. His staff consisted of two assistant directors : 
Lieut. -Colonel D. D. Shanahan for staff duties and Lieut.-Colonel 
W. W. O. Beveridge for sanitation. Colonel M. W. O'Keeffe 
mobilized as his deputy director of medical services on the 
lines of communication, with Major J. V. Forrest and Major 
H. B. Fawcus as his deputy assistants for staff and sanitary 
duties respectively.* An assistant director of medical services 
was appointed to the advanced basef and to each of the three 
sea bases, Havre, Rouen, and Boulogne. J 

These officers also embarked for France on the 9th August, 
1914. Major S. L. Cummins accompanied General Head- 
quarters. At the time of mobilization he was Professor of 
Pathology at the Royal Army Medical College. His duties 
at General Headquarters were not administrative, but those 
of medical charge of the officers and other details of the 

* Lieut.-Colonel Beveridge was the Professor of Hygiene at the R.A.M. 
College, Major Forrest was D.A.D.G., A. M.S. in the directorate of military 
operations at the War Office, and Major Fawcus was commanding the Army 
School of Sanitation at Aldershot. Their appointments ceased on mobilization. 
Colonel O'Keeffe had just gone on half-pay after completing his term of 
appointment as Inspector of Medical Services at the War Office. 

t Lieut.-Colonel G. H. Barefoot. 

J Colonels C. C. Reilly, S. Westcott, and E. H. Lynden-Bell. 



48 MEDICAL HISTORY OF THE WAR 

G.H.Q. staff. There were also on the staff of the A.D.M.S. of 
the three sea bases a medical officer for embarkation duties and 
a sanitary officer, and on the staff of the A.D.M.S. advanced 
base a sanitary officer. They were not, however, graded 
then as administrative officers. 

An assistant director of medical services with a deputy 
assistant as his staff officer mobilized with the headquarters 
of divisional formations as follows : 

Cavalry Division ... Colonel S. Hickson, A.D.M.S. 

Major E. T. F. Birrell, D.A.D.M.S. 
First Division ... Lieut. -Colonel G. Cree, A.D.M.S. 

Major A. B. Smallman, D.A.D.M.S. 
Second Division ... Colonel H. N. Thompson, A.D.M.S. 

Major F. S. Irvine, D.A.D.M.S. 
Third Division ... Lieut.-Colonel F. W. C. Jones, A.D.M.S. 

Major A. Chopping, D.A.D.M.S. 
Fourth Division ... Colonel C. E. Faunce, A.D.M.S. 

Major H. N. Ensor, D.A.D.M.S. 
Fifth Division ... Colonel R. H. S. Sawyer, A.D.M.S. 

Major J. H. Brunskill, D.A.D.M.S. 
Sixth Division ... Colonel H. O. Trevor, D.M.S. 

Major N. J. C. Rutherford, D.A.D.M.S. 

The formation of the divisions into three army corps was 
not provided for in the 1914 edition of the " Field Service 
Manual for the Army Medical Service," and consequently no 
administrative medical appointments were authorized for them 
in the tables of war establishments at the time of mobilization. 
But Colonel T. J. O'Donnell from half-pay was appointed 
a deputy director of medical services on the headquarters of 
the First Corps, and Colonel R. Porter, also from half-pay, 
on the headquarters of the Second Corps, each without 
a staff officer but assisted by the officer in medical charge of 
the headquarters staff. The Third Corps was not formed until 
later in France ; and Colonel O'Keeffe, from D.D.M.S., L. of C., 
was appointed its D.D.M.S., the post of D.D.M.S., L. of C., 
remaining vacant for some time afterwards. 

In the original mobilization scheme for the expeditionary 
force no provision was made for the appointment of consulting 
surgeons or physicians to the force, but it was soon recognized 
that their presence was essential and Lieut.-Colonels G. Makins 
and Sir Anthony Bowlby, who were officers of the 2nd London 
and the 1st London T.F. General Hospitals respectively, were 
sent to France, the former on the 16th September and the latter 
towards the end of the month as consulting surgeons. Previous 
to this the directorate of medical services at the War Office was 



MOBILIZATION 49 

anxious to send consulting surgeons to work under Surgeon- 
General Woodhouse, but during August he had telegraphed to 
say that as there were few seriously wounded coming down, 
there was no necessity for sending over either Lieut.-Colonel 
Makins or Lieut.-Colonel Sir A. Bowlby. In a letter, however, 
dated the 29th August explaining this, he asked that if it was 
the policy of the War Office to have consulting surgeons, one of 
these officers should be sent to General Headquarters and the 
other to the base at Havre. Arrangements were then made for 
them to go over to France with the temporary rank of colonel. 

Subsequently the number of consulting, surgeons and physi- 
cians appointed not only to the expeditionary force in France 
but also to expeditionary forces in other theatres of war was 
greatly increased. Consulting surgeons were appointed to 
each important base and to each army in the field, and, although 
the number of consulting physicians was somewhat fewer, 
they, too, eventually were appointed to armies in the field and 
to the bases. 

The appointment of specialists followed on the appointment 
of consultants, and by the end of 1914 specialists in operative 
surgery, bacteriology, and ophthalmology were approved for 
general and stationary hospitals from among R.A.M.C. officers, 
under the rank of lieutenant-colonel, who held qualifications in 
these subjects. These appointments and other special appoint- 
ments were subsequently extended to other formations, so 
that eventually there was a complete network of officers in 
charge of specialist work, with consulting surgeons, physicians 
and other consulting specialists supervising the work through- 
out the various expeditionary forces. 

Mobilization of medical units for the expeditionary force 
did not, however, cease on the despatch of the expeditionary 
force to France in August, 1914. New divisions, new armies 
and new expeditionary forces were created, for which new 
medical units had to be mobilized in proportion to their number 
and strengths. New classes of medical units were also brought 
into existence. Three new cavalry field ambulances, the 6th, 
7th and 8th, were sent to France in 1914, the 6th and 7th being 
formed of volunteers from various territorial force units. 
The 8th was the 1/lst Yorks. Mounted Bde. field ambulance 
of the territorial force. The 9th Cavalry Field Ambulance was 
formed at the R.A.M.C. depot and joined the expeditionary 
force in May, 1915. 

The 7th, 8th, 27th, 28th, and 29th Divisions, formed from 
regular battalions withdrawn from British garrisons overseas 
and India, with the addition of some battalions in the United 
Kingdom, were provided entirely with their field medical units 

(1735) E 



50 MEDICAL HISTORY OF THE WAR 

from existing territorial force field ambulances, with the 
exception of the 21st, 22nd and 23rd Field Ambulances of the 
7th division, which were mobilized at Southampton rest 
camp from R.A.M.C. withdrawn from overseas garrisons. 
Thus the 1st, 2nd and 3rd Wessex Field Ambulances became the 
24th, 25th and 26th Field Ambulances with the 8th Division; 
the 1st, 2nd and 3rd Home Counties, the 81st, 82nd and 83rd 
Field Ambulances with the 27th Division ; the 2nd and 3rd 
London and 2nd Northumbrian, the 84th, 85th and 86th Field 
Ambulances of the 28th Division, and the 1st West Lancashire, 
the 1st East Anglian and the 1st Highland, the 87th, 88th and 
89th Field Ambulances, which joined the 29th Division in Egypt 
in March, 1915. 

The divisions of the new armies when they mobilized for 
service overseas were accompanied by three field ambulances 
each, mobilized, with one or two exceptions,* from the various 
training centres and depots of the R.A.M.C. which had been 
formed to meet the expansion of the corps. 

Territorial force divisions went overseas with their own 
field ambulances, second line field ambulances being formed to 
replace those first line field ambulances which had been allotted 
to regular army divisions.! 

One clearing hospital, or, as it was subsequently designated, 
casualty clearing station, was also mobilized for each new 
division ; but some were taken, as in the case of the field 
ambulances, from the territorial force, although, on the other 
hand, some of thecasualty clearing stations formed to accom- 
pany trreitorial force divisions were mobilized from R.A.M.C. 
training centres. J 

In the original scheme of mobilization two stationary and 
two general hospitals were to mobilize with each division, and 
so long as these units were organized for 200 and 520 beds 
respectively new hospitals were formed and proceeded overseas 
in that proportion ; but as these expanded to units of 400 and 
1,040 beds, one stationary and one general hospital only mobi- 
lized with the new divisions, while eventually they mobilized 
irrespective of the number of divisions of the expeditionary 

* The 21st Division Field Ambulances, Nos. 63, 64 and 65, were second line 
territorial force field ambulances of the West Lancashire Division ; and the 
97th Field Ambulance of the 30th Division was the 2nd West Lancashire Field 
Ambulance Territorial Force. 

t Second line medical units were, in fact, formed by all the Territorial 
Force County Associations. 

J The territorial force clearing hospitals only came into existence in 1913 
and were merely a nucleus. Territorial Force County Associations were not, 
therefore, ready with complete clearing hospital units, as in the case of field 
ambulances. The West Riding division, however, had a clearing hospital 
mobilized in August and it went overseas as No. 7 Clearing Hospital. 



MOBILIZATION 51 

forces but more in accordance with the requirements of hospital 
accommodation in each theatre of war. 

Territorial force stationary hospitals did not exist and terri- 
torial force general hospitals were formed to proceed overseas 
only when an emergency arose in 1917. Territorial force 
general hospitals were then organized and went to France from 
the 1st and 2nd London, 1st Eastern, 2nd Southern, 1st Western, 
2nd Scottish, and 1st Northern General Hospitals.* They 
became the 53rd, 54th, 55th, 56th, 57th, 58th and 59th General 
Hospitals in France. With these exceptions all the stationary 
and general hospitals for the expeditionary forces, exclusive 
of those which mobilized with dominion forces, were mobilized 
from the R.A.M.C. training centres. Convalescent, depots were 
also increased in number in proportion to requirements, but 
most of these were organized out of elements already in the 
various theatres of war. 

Extensive additions were made to the number of sanitary 
sections. When the armies in France had settled down to 
stationary warfare the need of sanitary sections in the field 
to improve the sanitary conditions of towns and villages in 
which the troops were billeted was realized, and early in 1915 
a sanitary section was allotted to each division. They were 
mobilized and formed chiefly from -the London sanitary com- 
panies of the territorial force sanitary service. 

The proportion of ambulance trains and hospital ships mobi- 
lized to meet the increase in the number of divisions did not 
correspond with the scale laid down for the expeditionary 
force of six divisions. The number of these units was in- 
creased from time to time in accordance with the number of 
sick and wounded who, it was anticipated, would require 
transport to the bases and transfer to the United Kingdom 
in preparation for offensive operations. But when complaints 
regarding the type of ambulance train provided in the mobiliza- 
tion scheme reached the War Office, the directorate of medical 
services urged the despatch overseas of six of the ambulance 
trains which had been constructed in England for use in con- 
nection with the distribution of sick and wounded to hospitals 
in the United Kingdom. f In the meantime the first eleven 
ambulance trains were formed of rolling stock of the French 

* A territorial force general hospital, however, from the 3rd Western, had 
already gone to India in May, 1916. 

fThe mobilization scheme provided for the immediate construction of 
12 ambulance trains for use on the home railways. They were all ready by the 
end of August. The proposal to send six of them to France came before the 
military members meeting of the Army Council on the 19th September, 1914, 
when the possibility of altering them to suit French railways was considered. 
The alteration of one of the trains was ordered on the 29th September, 1914, 
with a view to being sent to France as early as possible. 

(1735) E 2 



52 MEDICAL HISTORY OF THE WAR 

railways. The trains which eventually mobilized were con- 
structed in England, some of them being generously provided 
by private donors and voluntary subscriptions. 

As regards hospital ships, the three ships mobilized as such 
with the expeditionary force in August were cross-channel 
passenger steamers belonging to the Great Western Railway 
Company. They proved inadequate to meet the requirements 
of evacuation and more and larger hospital ships were imme- 
diately demanded. Thus the "Asturias " mobilized on the 
28th August, 1914, and the " Carisbrook Castle " on the 20th 
September, 1914. They were continually being added to, 
especially when an Indian contingent joined the expeditionary 
force in France and expeditionary forces entered theatres of 
war in the Mediteraranen. Eventually a great fleet of hospital 
ships was mobilized. Additional advanced and base depots 
of medical stores were mobilized partly from personnel and 
equipment already with the expeditionary force in France 
and partly from the depot of medical stores at Woolwich. 

The principle of employing mechanical transport with medical 
units led to the formation of new classes of medical units not 
contemplated in the original scheme of mobilization. These 
were the motor ambulance convoys and various descriptions 
of mobile laboratories. When the expeditionary force sailed 
for France, the general scheme of ambulance transport for the 
collection of sick and wounded to the main dressing stations 
depended on the ambulance wagons of the field ambulances and, 
for bringing them back to the clearing hospitals and ambulance 
trains, on the mechanical transport of supply columns returning 
empty to railheads, supplemented by such local transport as 
could be requisitioned for the purpose. This scheme broke 
down from the commencement of operations owing chiefly 
to the fact that the empty supply column vehicles did not 
form a unit under the control of the medical services. There 
was always the risk of conflict between the urgency of getting 
them back for supplies and their retention by the medical ser- 
vices until they had received and discharged their loads of 
wounded. The need of mechanical transport under the control 
of the medical services was also felt at the bases for bringing 
the sick and wounded from the trains to the hospitals, some 
of which were being opened at a considerable distance from the 
detraining stations. 

These considerations led to the despatch to France by the 
War Office of large numbers of motor ambulance cars which 
were eventually formed into definite R.A.M.C. units as motor 
ambulance convoys. In a letter dated the 20th August, 1914, 
the D.M.S. informed the D.G., A.M.S., that he had demanded 



MOBILIZATION 53 

60 motor ambulance cars for this purpose. As many as possible 
of the existing motor ambulance cars belonging to the military 
authorities in the United Kingdom were then sent to France. 
Very few existed in the country, but seven of them went overseas 
between the 22nd and 24th August, 1914. At this time the 
Wolseley Company had six-cylinder chassis of many cars 
ready for private purchasers and placed them at the disposal 
of the War Office, together with many of their employees who 
specially enlisted in the Army Service Corps as drivers. Ambu- 
lance car bodies of a type approved by the War Office were 
rapidly built on the chassis. Fifty went to France on the 
7th September, 1914, and 30 more by the end of the month. 
These cars were eventually organized as No. 1 Motor Ambulance 
Convoy. A second convoy was formed shortly afterwards out 
of a heterogeneous number of cars got together in Paris by the 
representatives of the British Red Cross Society there. They 
were eventually replaced by cars with War Office pattern bodies, 
and became No. 2 Motor Ambulance Convoy. By this time the 
formation of motor ambulance convoys, in proportion to the 
number of divisions in the field, had become definitely author- 
ized, and the War Office by the end of 1914 had prepared and 
despatched as many as 324 motor ambulance cars to France. 
From them the 3rd and 6th Motor Ambulance Convoys were 
formed. No. 4 Convoy was formed by cars provided by the 
British Red Cross Society, and No. 5 by Captain du Cros, M.P., 
who formed the convoy and took it over at his own expense. 
These formed the first motor ambulance convoys. Subse- 
quent convoys were made up of motor ambulance cars presented 
by various generous donors, local committees, and the British 
Red Cross Society and Order of St. John, as well as of cars 
purchased by the War Office. Thus No. 7 Motor Ambulance 
Convoy cars were all presented by the Maharajah of Gwalior ; 
No. 8 by the Scottish boroughs and counties. By the end of 
1915 eighteen motor ambulance convoys had been sent 
overseas. They became the units for transport of sick and 
wounded between field ambulances and clearing hospitals, 
and between clearing hospitals and railheads, those units, 
in fact, which were foreshadowed as essential in the 
memorandum submitted by the medical section of the 
directorate of military operations in 1906.* The total number 

* See p. 11. Motor ambulance cars also replaced a proportion of horse- 
drawn wagons in field ambulances for transport of sick and wounded from 
the advanced to the main dressing station. The 8th Division was the first 
to mobilize with this change in the transport of its field ambulances. It 
went to France during the first week of November, 1914. At a meeting of 
the military members of the Army Council on the 21st October, 1914, it 
was decided that all future field ambulances and cavalry field ambulances 
should be equipped on the same scale as for the 8th Division, namely, three 
horse ambulance wagons and seven motor ambulance cars. 



54 MEDICAL HISTORY OF THE WAR 

of convoys mobilized before the termination of the war 
was 48. 

Mobile laboratories, fitted on motor chassis, were mobilized 
from time to time and became definitely organized units in 
new war establishments. The first of these was a bacteriological 
laboratory which arrived in France in October, 1914. It was 
followed by a hygiene laboratory in November of the same year. 
Subsequently these laboratories were mobilized in the propor- 
tion of two bacteriological and one hygiene mobile laboratory for 
each army in the field. Mobile X-ray laboratories and mobile 
dental laboratories were also mobilized, the earliest of the former 
class proceeding to France when trench warfare had been 
established on the Flanders front, and of the latter in the 
spring of 1917. Many of these laboratories were presented 
to the War Office by private donors. 

Another new class of medical unit evolved subsequent to 
mobilization was the ambulance flotilla. The first flotilla was 
organized on the Seine in 1914, when a flotillawas formed to 
bring patients from Paris to Rouen. Subsequently four 
additional flotillas were formed of six barges each, for use 
on the Calais and Dunkerque system of canals leading to the 
Flanders front and on the Somme. These were constructed 
and mobilized in France. Others were prepared in England 
for work in Mesopotamia. 

The number of medical units mobilized in the United 
Kingdom for expeditionary forces was 235 field ambu- 
lances and cavalry field ambulances, 78 casualty clearing 
stations, 48 motor ambulance convoys, 63 ambulance trains, 
4 ambulance flotillas, 38 mobile hygiene and bacteriological 
laboratories, 15 mobile X-ray units, 6 mobile dental units, 
126 sanitary sections, 18 advanced depots of medical stores, 
17 base depots of medical stores, 41 stationary hospitals, 
80 general hospitals, and some convalescent depots. In 
addition, several medical units of the Indian Army or Dominion 
Forces were mobilized as well as hospitals organized for native 
labour contingents. 

The mobilization orders issued on the 4th August, 1914, 
affected not only the medical services required for the expedi- 
tionary force but also for the whole of the organized military 
resources of the empire. Consequently the mobilization of 
military hospitals and coast defences at home proceeded 
according to a pre-arranged scheme. As officers and men of 
the R.A.M.C. were withdrawn from their peace stations to 
mobilize with the expeditionary force they were replaced by 
the home hospital reserve of the St. Jolin Ambulance Brigade 
and St. Andrew's Ambulance Association. The scheme worked 



MOBILIZATION 55 

well, and by the 10th August all members of this reserve 
had reported for duty at the military hospitals to which they 
had been allotted. The home hospital reserve of the St. John 
Ambulance Brigade had then a strength of 2,200 and the 
home hospital reserve for Scotland of the St. Andrew's 
Ambulance Association 113. These numbers were greatly 
increased and 15,871 men of the St. John Ambulance Brigade 
had been called up and were serving in military hospitals at 
home by the end of 1915. 

The mobilization of the territorial force medical services 
was carried out with the same expedition as and -pari passu with 
the mobilization of the expeditionary force. In one respect 
their medical units differed from those of the R.A.M.C. in that 
their field ambulances existed as complete units in time of peace 
and each of the territorial force fighting units had its own 
medical officers. The general hospitals, although non-existent 
in peace, had their permanent cadre establishments of two 
officers and a quartermaster and a large a la suite establishment, 
from which the required number of medical officers were to 
be selected on mobilization. The number so selected was 
restricted to eighteen, which, with the permanent cadre, 
brought the number mobilized up to the war establishment 
of a general hospital of 520 beds. 

The regimental medical service and field ambulances of the 
territorial force were in being immediately after the issue of 
mobilization orders. For mobilization of the general hospitals, 
plans which had been prepared and approved were adhered 
to in most cases, but they were expanded or modified subse- 
quently in various ways. All, however, mobilized with great 
rapidity and were practically ready to receive patients by the 
end of August, 1914. One, indeed, was ready to receive a limited 
number of patients as early as the 7th of the month. 

Four of these hospitals were opened in London, two in 
Glasgow, and one each at Cambridge, Brighton, Newcastle, 
Leeds, Sheffield, Lincoln, Leicester, Aberdeen, Edinburgh, 
Birmingham, Portsmouth, Oxford, Bristol, Plymouth, Liver- 
pool, Manchester, and Cardiff. These twenty-three territorial 
force general hospitals of the original mobilization scheme were 
eventually increased to twenty-five by converting the accom- 
modation set apart in St. Thomas's Hospital for military 
patients into a 5th General Hospital in London in August, 1915, 
and by opening a second line general hospital of the 1st Southern 
General Hospital in Birmingham in May, 1915. 

Briefly, therefore, during August, 1914, complete medical 
services of the expeditionary force mobilized and went to 
France ; the medical services of the territorial force were in 



56 MEDICAL HISTORY OF THE WAR 

being in the United Kingdom ; and the military hospitals and 
coast defence medical services at home were provided with 
personnel from the home hospital reserve of the St. John 
Ambulance Brigade, the St. Andrew's Ambulance Association, 
and from the reserve nursing services of the Q.A.I.M.N.S. and 
Princess Christian's army nursing service reserve. 

There were still, however, other organized voluntary aid 
services, the voluntary aid detachments, ready and eager to 
mobilize immediately on the outbreak of war. As already 
described, they were organized by county directors under the 
Territorial Force County Associations, the majority by the 
British Red Cross Society, but some by the St. John Ambulance 
Association and Brigade and a few by the Territorial Force 
Association of the county concerned. On the 1st August, 1914, 
there were 543 men's and 1,811 women's detachments with a 
total personnel of 23,047 men and 47,196 women registered by 
the War Office. In England, Wales, and the Channel Islands 
the British Red Cross Society had organized 282 of the men's 
and 1,225 of the women's detachments, and in Scotland 109 
men's and 337 women's ; the St. John Ambulance Association 
and Brigade had 127 men's and 197 women's detachments in 
England, Wales, the Channel Islands, and Isle of Man, and the 
Territorial Force County Association 25 men's and 52 women's 
detachments in England and Wales. There were at that time 
no voluntary aid detachments registered from Ireland, although 
after war had been declared 15 men's and 157 women's were 
organized there by the St. John Ambulance Association.* 

The declaration of war was received by this vast organization 
of voluntary workers in aid of the sick and wounded with eager 
enthusiasm. They were anxious to put at once into practice 
the schemes for which, under their county directors, they had 
been preparing and training themselves in the days of peace. 
In some counties their zeal led at first to considerable adminis- 
trative embarrassment and conflict with the authorities of 
the Board of Education. Local schools were invaded, school 
equipment turned out, and the buildings converted into ad- 
mirably arranged local hospitals long before it was possible 
or necessary for the military authorities to utilize auxiliary 
hospitals and before authority to mobilize had been conveyed 
to county directors. The most useful work carried out by some 
of the county directors in August, 1914, was the preparation of 
a general scheme for mobilizing and working their voluntary aid 
detachments, whenever they were required, and standing fast 

* There was a general increase in the number of detachments before the 
close of the war. Thus on the 1st October, 1919, the totals were 902 men's 
and 3,015 women's, with a personnel of 41,155 men and 85,391 women. 



MOBILIZATION 57 

until then. This was notably so in the county of Northampton, 
the Territorial Force Association of which submitted to the War 
Office early in September a scheme for utilizing voluntary aid 
so excellently thought out and prepared by their county director 
of voluntary aid detachments that the Army Council expressed 
their appreciation of it in a letter' to the association, stating that, 
as no place had been taken over or anything disturbed in any 
way until such time as the various organizations in the scheme 
would be required, the scheme was the kind of arrangement 
which was of the greatest value to the Army Council and the 
Council hoped it would be imitated in other counties. 

Throughout this early period of mobilization the Army 
Council communicated repeatedly with the home commands 
with a view to restraining the mobilization of the voluntary aid 
detachments or at any rate preventing them taking over 
educational buildings until it was essential in the interests of 
the sick and wounded to do so. The situation, therefore, as 
regards the mobilization of voluntary aid detachments in 
August, 1914, was officially one of restraint, but at the same time 
of encouragement to prepare schemes which should be put into 
operation whenever the time came for them to be used. 
The British Red Cross Society had been authorized in Field 
Service Regulations as the channel through which all other 
offers of voluntary aid in time of war should be submitted 
to the War Office. At the beginning of the war, however, the 
Society's organization and premises were inadequate for dealing 
with the overwhelming and conflicting mass of offers of assist- 
ance which poured into the War Office. Larger premises and 
a wider organization were eventually obtained to meet the 
requirements of voluntary aid organization and administrative 
measures were taken to make the liaison between the Red Cross 
organization and the military authorities more effective. 



CHAPTER IV 

ADMINISTRATION OF THE MEDICAL SERVICES 

A FTER war was declared an immense amount of new work 
.xV was thrown on the administrative medical services at 
home. Administrative measures were urgently demanded for 
the expansion of hospital accommodation, for the reception and 
distribution of sick and wounded arriving from overseas and 
for their final disposal. Special medical arrangements were 
required for the home forces, for sick and wounded of Dominion 
and Indian troops, and for those of Allied armies and prisoners 
of war sent to England. The medical examination of recruits 
and the recruiting and training of medical personnel for the new 
armies, the sanitation of overflowing camps and billets, especially 
in relation to the civil population, the purchase, maintenance 
and despatch of vast amounts of medical and surgical supplies, 
the co-ordination and control of voluntary aid and other matters 
of greater or less importance presented new administrative 
problems, to meet which practically no provision had been made 
before war was declared. 

The directorate of the Army Medical Service at the War 
Office consisted at the time of a small staff of officers in 
the department of the Adjutant-General. Surgeon-General 
Sir A. T. Sloggett was director-general. He had taken 
up the appointment from Surgeon-General Sir L. Gubbins 
as recently as the 1st June, 1914. Surgeon-General W. G. 
Macpherson was his deputy director-general, having been 
appointed in March, 1914, in succession to Surgeon-General 
W. Babtie, who had proceeded to India as director of medical 
services there in place of Sir Arthur Sloggett. The work of the 
directorate was carried out in five branches, namely, a branch 
dealing with personnel and technical training of officers and 
men of the R.A.M.G. ; a branch dealing with questions of 
sanitation, hospital accommodation, recruiting, statistics and 
cognate subjects ; a branch dealing with questions of hospital 
equipment, medical and surgical supplies, medical boards, 
professional matters, and voluntary aid ; a branch dealing with 
organization, mobilization and preparation of the medical ser- 
vices for war ; and a section for nursing services. The first 
branch was in charge of an assistant director-general, Lieut. -Col. 
C. H. Burtchaell, the nursing section in charge of the matron- 

58 



ADMINISTRATION 59 

in-chief of the Q.A.I.M.N.S., Miss Becher, and the three other 
branches in charge of deputy assistant directors-general, Majors 
H. P. W. Barrow, G. B. Stanistreet, and W. R. Blackwell. 

Lieut. -Colonel C. H. Burtchaell was just completing his four 
years' tenure of the appointment of assistant director-general. 
Lieut. -Colonel A. P. Blenkinsop had been nominated to replace 
him, and when war was declared had just arrived from India 
on completing a tour of service there. He was attached for 
duty at the War Office on the declaration of war to assist in 
dealing with questions of expansion of hospital accommodation 
by private effort. Miss E. H. Becher was assisted by Miss 
E. M. McCarthy as her principal matron. The latter, however, 
was mobilized with the expeditionary force and proceeded to 
France on the 12th August, 1914, as matron-in-chief there, 
a post which she held until the end of the war. She was not 
replaced at the War Office until the 19th September, 1914, 
when Miss E. S. Oram was appointed on her return from acting 
as principal matron in South Africa. 

Major Stanistreet had held his appointment since January, 
1913, but Majors Barrow and Blackwell had only joined the 
directorate in April and May, 1914, respectively. The medical 
section in the directorates of military operations and training, 
and the inspectorate of medical services were closed on the 
declaration of war, as was also the Royal Army Medical College. 
The territorial force medical service was not represented on 
the director-general's staff, but there was a matron-in-chief 
in charge of its nursing service. The periodical meetings of 
the army medical advisory board and nursing board were in 
abeyance for the time being. 

During the first two months of the war no additions to or 
changes were made in the directorate, and this comparatively 
new and small administrative staff carried on the work of the 
directorate under conditions of severe strain, accentuated by 
the serious illness of the director-general, which kept him from 
duty at a critical time during the whole of September and part 
of October. In his absence his duties devolved on the deputy 
director-general . 

In October, 1914, a change of policy in the administration 
of the medical services both at home and overseas resulted in 
the director-general of the Army Medical Service and his deputy 
director-general proceeding to France. Difficulties had arisen 
in connection with the desire of voluntary aid organizations 
and private individuals to take a more prominent part than 
was permissible in the medical arrangements for the care of 
the sick and wounded in the field. Large sums of money 
'were being subscribed to the British Red Cross Society and 



60 MEDICAL HISTORY OF THE WAR 

other organizations, inducing them to seek an outlet for their 
activities in a manner which would justify more convincingly 
the appeals for funds that were being made in, and supported 
by, an influential press.* 

Although their spirit and intentions were admirable and 
worthy of every consideration, some of the proposals were in con- 
flict with military possibilities and requirements, and, in certain 
instances, involved violations of the Geneva Convention at a 
time when even a slight infraction of the Convention might be 
made the excuse for serious reprisals on the part of the enemy. 
The influences which were at work at the time, however, became 
more and more insistent, and in order to avoid undesirable 
complications and friction Lord Kitchener decided to send 
the director-general to France, not only as director-general 
of medical services there, but also, with the consent of the 
British Red Cross Society and Order of St. John of Jerusalem, 
as Chief Commissioner of the Joint War Committee which these 
two bodies were then establishing. At the same time, Sir Alfred 
Keogh, who had been director-general of the Army Medical 
Service from 1905 to 1910, and was in France as Chief Commis- 
sioner of the British Red Cross Society overseas, returned from 
France at the beginning of October and was appointed to take 
Sir Arthur Sloggett's place at the War Office. 

Sir Arthur Sloggett went to France on the 28th October with 
Lieut.-Golonel C. H. Burtchaell as his staff officer. Surgeon- 
General W. G. Macpherson had preceded him on the 17th 
October, and was succeeded as deputy director-general at the 
War Office by Colonel M. W. Russell.f Lieut-Colonel A. P. 

* The retreat from Mons, the inadequate ambulance train arrangements, 
which have already been alluded to, and the sudden change of hospital bases 
from the Channel to Atlantic ports, with their effect on the general scheme 
of evacuation of wounded, created the impression that the medical service 
organization had broken down. Although voluntary aid organizations were 
far from being in a better position to deal with the situation than the regular 
army medical service and the responsible military authorities, there was 
a tendency to create a different impression in the public mind, and an appeal 
in the Times of the 29th August, 1914, was to the effect that " the British 
Red Cross Society is in urgent need of more funds if effective and immediate 
aid is to be given to the sick and wounded at the front." The Army Council 
in consequence of this public announcement found it necessary, in a letter 
of the 31st August, 1914, to draw the attention of the British Red Cross Society 
to their advertisement, pointing out that its terms amounted to a suggestion 
that effective and immediate aid to the sick and wounded at the front was 
not being provided by the responsible authorities ; and that although the 
suggestion was of course not intended it was clear that misunderstanding on 
the subject might well arise in the minds of the public. The Army Council 
accordingly requested the secretary of the society to cause the wording of 
the announcement to be altered in a manner which would avoid all risk of such 
a misunderstanding. 

t He remained at the War Office as D.D.G. till the 26th December, 1917, 
when he was placed on the retired list on account of age, ana was succeeded 
by Colonel T. H. J. C. Goodwin. 



ADMINISTRATION 61 

Blenkinsop took Lieut. -Colonel Burtchaell's place as assistant 
director-general and handed over his work in connection with 
voluntary hospitals to Major E. T. Inkson. 

The plan of combining the function of chief commissioner of 
voluntary aid organizations with that of the director-general 
of medical services of the expeditionary force was a happy 
solution of the administrative difficulties which were being 
created. It worked admirably throughout the war. Its 
success was essentially due to the fact that the regular organiza- 
tion of the army medical service was no longer subject to the 
conflicting interests and rivalries of the voluntary aid organiza- 
tions, and that both afterwards worked harmoniously under 
one control. 

After Sir Alfred Keogh had taken over the administration 
of the medical services at the War Office many additions were 
made to his staff, partly to assist in the administrative details 
of special branches of medicine, surgery, and hygiene, and partly 
in order to deal with the ever-increasing mass of routine work 
consequent on the opening up of new theatres of war, the ex- 
pansion of the forces, and the disposal of the sick and wounded. 
In October, 1914, Colonel C. Beatson, a retired officer of the 
Indian Medical Service, was attached to the assistant director- 
general's branch for duty in connection with the establishment 
of hospitals in England for the Indian contingents then arriving 
in France, but it was not until a year afterwards that a section 
in the personnel branch was sanctioned for the territorial 
force medical services. In October, 1916, an officer was 
appointed to the personnel branch to assist in obtaining medical 
men for the army. Other additions to the personnel branch 
were made in October and December, 1917, when officers were 
attached to it to assist the assistant director-general and to 
scrutinize the proceedings of medical boards; and again in 
March, 1918, when an officer and staff of military clerks 
were added to the branch in order to deal with card 
indices of R.A.M.C. officer personnel. In the same year 
three other officers were attached to deal with man-power 
statistics. The officer who was appointed to assist the assistant 
director-general in December, 1917, became an additional 
deputy assistant director-general in the branch in June, 1918. 
In January, 1918, Lieut. -Colonel J. P. Helliwell was appointed 
to represent the dental services in the personnel branch of the 
director-general's staff, and to advise generally in connection 
with dental services,which were becoming an important element 
in the general work of the Army Medical Service both at home 
and overseas. 

Lieut. -Colonel Blenkinsop vacated the appointment of A.D.G. 



62 MEDICAL HISTORY OF THE WAR 

at the end of February, 1917, on being appointed D.M.S. of 
the Mesopotamia expeditionary force, and for a time the 
duties of the branch, until March, 1918, were under the super- 
vision of Surgeon-General Sir W. Babtie, with Lieut. -Colonel 
Sir E. S. Worthington in actual charge as a D.A.D.G. In 
March, 1918, Sir E. Worthington was officially appointed 
A.D.G. As Surgeon-General Sir W. Babtie's appointment at 
the War Office was that of a D.M.S. he had been so appointed 
in March, 1916, on his return from India and Egypt there was 
no A.D.G. in the personnel branch between March, 1917, and 
March, 1918. 

Lieut.-Colonel Barrow proceeded to France in June, 1916, and 
was succeeded by Lieut.-Colonel A. L. A. Webb as D.A.D.G. in 
the branch dealing with hospital accommodation, sanitation, 
and statistics. In October, 1914, an officer was attached for 
duty as an assistant to the D.A.D.G. in this branch, and in 
January, 1915, Mr. T. R. Walrond was lent to the War Office 
by the Board of Education to succeed Major Inkson in dealing 
with accommodation for hospitals. Owing to his intimate 
knowledge of educational requirements he was of great assist- 
ance to the director-general in connection with the acquisition 
of educational buildings for hospital purposes. In July, 1915, 
another officer was appointed to it in connection with the main- 
tenance of statistics of sick and wounded and of statistics 
generally. In April of 1917 Lieut.-Colonel Webb was graded 
as an A.D.G., and obtained several further additions to 
the staff of the branch. Amongst others, a D.A.D.G. for 
sanitation was appointed to the branch in August, 1917, and 
a separate section was formed to deal with the transfer 
of sick and wounded officers from hospitals in one command in 
the United Kingdom to hospitals in another and to auxiliary 
convalescent hospitals and command depots, a section which 
occupied the time of two temporary officers of the R.A.M.C. 
In March, 1918, another section was opened, which also 
required the assistance of wo temporary R.A.M.C. officers, 
to deal with medico-legal questions. Lieut.-Colonel Webb was 
transferred to the Ministry of Pensions at the beginning of 
1919, and was succeeded by Major A. B. Smallman as A.D.G. 

Lieut.-Colonel G. B. Stanistreet was appointed A.D.G. on the 
28th February, 1917, but continued in charge of the medical 
and surgical supply branch until March, 1918, when he was 
appointed D.D.G. Colonel J. R. McMunn succeeded him as 
A.D.G. on the 1st March, 1918. The additions to this branch 
during the war were the appointment, in December, 1914, 
of an officer to assist in medical board and pensions work, 
being graded eventually as a D.A.D.G. in the branch in 



ADMINISTRATION 63 

September, 1915. In June, 1915, an officer was added to 
the branch to deal with the supply of medical and surgical 
stores and equipment for hospitals, and in August of 
the same year another officer was appointed to deal with 
the arrangements for the treatment of cholera. In August, 
1917, an officer was appointed in connection with the organiza- 
tion for the supply of spectacles, microscopes, sight-testing 
appliances, operation room furniture, and various other matters 
connected with the despatch of medical and surgical stores for 
shipment overseas, and the branch was further assisted by 
various technical experts and advisers. 

Major Blackwell's branch dealing with organization, mobiliza- 
tion, and preparation of the medical services for war was merged 
into that of the A.D.G. in charge of personnel, and disappeared 
as a separate branch on the outbreak of the war. The D.A.D.G. 
in charge of the branch then became a D.A.D.G. in the personnel 
branch. 

The administration of the nursing services was more central- 
ized than that of the other branches of the director-general's 
department, as there were no representatives of the matron- 
in-chief on the staff of the administrative medical services 
of commands at home, and no machinery existed on the out- 
break of war for decentralization of the work. The only addi- 
tion to the peace staff* in 1914 was that of three additional 
lady secretaries. With slight additions to the staff, Miss Becher 
continued to administer the nursing services, with the assistance 
of a principal matron only, until she broke down in health in 
June, 1917. She resumed her duties, however, in December, 
1917, and was then given a staff of one principal matron, one 
acting principal matron, one matron, and four lady secretaries, 
in addition to a comparatively large staff of male and female 
clerks. During her absence between June and November, 
1917, Miss Wilson was appointed to take charge of the nursing 
section, with Miss G. M. Richards as principal matron, j 

In addition to the expansion of the director-general's staff 
outlined above, consulting specialists, committees and boards 
were appointed to advise him or the Army Council on technical 
details connected with the medical services. A standing medical 
board was appointed at the War Office immediately after war 

* The peace staff consisted of the matron-in-chief, a principal matron, one 
secretary, and two ex-soldier clerks. 

f Miss Oram was appointed matron-in-chief of the Egyptian expeditionary 
force in April, 1915, and was succeeded by Miss Wilson, who, however, 
left the War Office as principal matron of the Salonika expeditionary force 
in November, 1915. She was recalled from this post to act as matron -in-chief 
during Miss Becher's absence. Miss Richards was appointed as an acting 
principal matron when Miss Wilson was transferred Salonika to. 






64 MEDICAL HISTORY OF THE WAR 

was declared in order to examine candidates for temporary 
commissions and as a headquarters medical board. It was 
composed of officers of the R.A.M.C. who had retired from the 
service, and was under the presidency of Colonel C. R. Tyrrell. 
An Army Sanitary Committee was reconstituted in November, 
1914, to advise on all matters connected with the health of 
the army at home and overseas, under the presidency of 
Brig.-General F. J. Anderson, R.E. Representatives from the 
Local Government Board and the India Office, together with the 
military and civil sanitary experts of the Army Medical Advisory 
Board and certain others, were members of this committee. 
In December, 1914, Colonel Sir Ronald Ross was appointed to 
advise the director-general in connection with malaria, and 
Colonel J. R. Reece for similar duties in connection with 
cerebro-spinal meningitis. In March, 1916, Sir Robert Jones 
was appointed to inspect and organize a system of 
orthopaedic treatment of war injuries,* and in November of 
the same year, Dr. E. N. Burnett was appointed to carry 
out investigations with a view to economy in the adminis- 
tration of hospitals, especialy in regard to kitchens and 
hospital diets. His work was of a far-reaching character 
and proved of immense value at a tune when shortage 
of supplies was becoming serious and the utmost economy 
essential. 

A council of consulting surgeons and physicians, with 
Major-General Sir B. Moynihan, A.M.S., as president, was 
appointed to advise on professional and other matters, and 
committees were formed to deal with such questions as the 
retention and distribution of medical officers in the United 
Kingdom ; economy in the internal administration of hos- 
pitals ; cerebro-spinal fever ; selection of electro-medical 
apparatus ; the medical aspects of chemical warfare ; patterns 
of surgical instruments, appliances, and medical stores ; 
prevention and treatment of tetanus ; prevention and control 
of dysentery ; selection, inspection and testing of X-ray 
apparatus and training of orderlies in their use ; pathological 
enquiries and pathological work in the army generally.! 

* Assistant inspectors of orthopaedics were also appointed in commands, 
and one of them, Major A. M. Paterson, was attached for dut)' at the War. 
Office as assistant to Sir Robert Jones. 

f The active members of these committees were : Sir B. Moynihan 
(Medical Officers Committee), Dr. E. N. Burnett (Hospital Economy), Surg.- 
Colonel J. R. Reece (Cerebro-spinal Meningitis), Capt. W. R. Bristow (Electro- 
medical), Prof. A. R. Cushny (Chemical Warfare), Colonel F. F. Burghard 
(Surgical Advisory Committee), Surgeon-General Sir D. Bruce (Tetanus), 
Colonel Sir W. B. Leishman (Dysentery), Lieut. -Colonel A. D. Reid (Radi- 
ology), Surgeon-General Sir D. Bruce (Pathology). 



TABLE OF WAR ORGANIZATION FOR ADMINISTRATIVE 
MEDICAL SERVICES IN THE UNITED KINGDOM UNDER CONTROL 



OFD.G.A.M S. AT THE WAR OFFICE AT THE TIME OF THE 
ARMISTICE AND AFTER. 




ASST INSPECTOR 

|oFMEDicAisERviCEs| 



M.t.'/. 





^ ARMY MEDICAL 
ADVISORY BOARD 


.,STANDI 
BO 


46 MEDICAL 
ARD 


SPECIALIST COMMITTEES CH 
and INSPECTORS for MED 


EF 
ICAL 






Examination of Officers 


te'rS&ipin.lM.ning.ds CONTROLLED 






/f.M.M.C. fbrCumtnissions 


gysyfite 


^ Q.M.A.A.C. 






Referred Cases. 


Kadiofof. 
Orthopl 


t* 














oacter 
Council 


ology 
ofconsuttina 










Surgeons & Physicians. 
Hospital economy inci 










admmii 
Chemic 


tra-ttan. 
at Warfare. 


I.G.I. 


1 
A.D.G.2. 


A.C 


1 
).6.3. +MAITOH-II+CHIEF 


DIRE( 


1 

:TOROF DIRECTOR OF 


.D.G. 


* D.A.D.G. 


*D.A.0.6. *PRINCIWL- MATRON 


HYGIENE 


PATHOLOGY 


.D.G. 


D.A.D.G. 


D.A.D.G. PRINCIPAL-MATRON 


DEPUTYDIRECTOR DEP DIRECTOR 


.D.G.i 


F. 4 ATTACHED 


D.A.D.6. MATRON 


OF HYGIENE OFPATHOIDGY 


ICTOR 


OF OFFICERS 


INSPECTOR 3 SECRETARIES 


AS5TDIRECTOR ASSTHRECTOR 


ALSE 


RVICES AllStnitary 
Questions . 
Hospital 


.MFD.SUPPLIES Ad m ,ni,tr*t:-onof 
ASSTINSPEaOR Nursing Servicma 


OF HYGIENE 


OFWiTHOUOGY 


TACUpn Accommodation MED.SUPPLIES 


lvn 

r?p<! 


Statistics 


6 ATTACHED 


wfint 

>/>>?/. 


OFFICERS 


/n 5 ff>(.*f.C. 


Medic*! SSurgicitSueplies. 


<// 


ISvrviw 


Mdi 


cat Bon-ds. 








iMi 


jns for 


Cbir 


ns. 








'l'*t 


n 


Volui 


ttaryAId. 








Ct( 

#1*1 


" < 













0. M. S. 
EMBARKATION 



D.M.S. 
HOME FORCES 



* D.Ds.M.S. 
OFCOMMANDS 

(Aldrshot,astorn, Irish. 
London. tfarthtrn,Scottlsh, 
-Southern, Wsstern) 



* Appointments marksd with asterisk existed before the war. 
These appointments were not made until 1913:- 

The Administrative Medical Services shewn in double lines belong tc Commands 

outside the War Off ice. 



ADMINISTRATION 65 

In March, 1918, Sir Alfred Keogh retired from the post of 
director-general at the War Office. He was replaced by 
Lieut. -General Sir T. H. J. C. Goodwin, and in the following 
month the Army Medical Advisory Board was re-constituted. 

When the Women's Army Auxiliary Corps was formed, the 
administration of its medical service came under the control 
of the director-general, and for this purpose an auxiliary 
section was formed at the War Office in November, 1917. It 
was placed under the charge of a medical controller.* She 
was represented by a medical controller at G.H.Q. overseas 
and by an area medical controller at the headquarters of 
commands at home and in areas overseas, in addition to 
subordinate administrative medical controllers and adminis- 
trators for recruiting and for the medical charge of women. 

The administration of the medical service in the commands at 
home became complicated and difficult chiefly on account of 
the vast increase in hospital accommodation and the numerous 
varieties of hospitals which were established with their different 
methods of administration and heterogeneous personnel. The 
variety and number of medical boards and regulations for 
the disposal of sick and wounded and the pressing needs of 
sanitary work and supervision of camps and billets also added 
greatly to the difficulties of administration in the various com- 
mands. The staff of the D.D.M.S. of a command, however, was 
not increased officially during the war, but additional officers 
were attached for duty in his office as required ; and the 
D.D.M.S. was still further assisted by consulting surgeons and 
physicians, inspecting dental officers, inspectors of hospitals, 
medical controllers Q.M.A.A.G., specialist sanitary officers, 
and mental and other specialists ; forming a considerable staff 
as compared with his peace establishment, which consisted 
only of one specialist sanitary officer and an attached officer. 

Further, while the Eastern, Southern, and Irish Commands 
had before the war certain districts under the administrative 
medical charge of an A.D.M.S. who was subordinate to the 
D.D.M.S., new districts were formed to meet war requirements, 
especially in those commands where none previously existed. 
In this way seven new districts were formed in the Northern, 
two in the Scottish, and four in the Western Command, while 
in the Southern and in the Eastern Commands the original 
three and four expanded to eight and six respectively at one 
time. The Irish Command retained its original three districts. 
The expansion of administrative districts was gradual, and had 
not reached its full limit until demobilization had set in. The 
distribution of administrative medical services in commands 

* Dr. J. H. Turnbull, Q.M.A.A.C. 
(1735) F 



66 



MEDICAL HISTORY OF THE WAR 



was then as follows, those marked with an asterisk being 
original districts : 

Alder shot. D.D.M.S. and Headquarters Staff. 
*A.D.M.S. Bordon. 
A.D.M.S. Bramshott. 
A.D.M.S. Witley. 

London. D.D.M.S. and Headquarters Staif. 

Eastern. D.D.M.S. and Headquarters Staff. 
*A.D.M.S. Dover. 
*A.D.M.S. Woolwich. 
*A.D.M.S. Chatham. 
*A.D.M.S. Colchester. 

A.D.M.S. Bedford. 

A.D.M.S. Sussex. 

Irish. D.D.M.S. and Headquarters Staff. 

*A.D.M.S. Dublin. 
*A.D.M.S. Belfast. 
*A.D.M.S. Cork. 

Northern. D.D.M.S. and Headquarters Staff, 
A.D.M.S. Tyne. 
A.D.M.S. Catterick. 
A.D.M.S. Ripon. 
A.D.M.S. Humber. 
A.D.M.S. Cannock Chase. 
A.D.M.S. 69th Division. 
A.D.M.S. Grantham. 

Scottish. D.D.M.S. and Headquarters Staff 
A.D.M.S. Eastern (Perth). 
A.D.M.S. Western (Glasgow). 

Southern. D.D.M.S. and Headquarters Staff. 
*A.D.M.S. Portsmouth. 
*A.D.M.S. Tidworth. 
*A.D.M.S. Devonport. 

A.D.M.S. Birmingham. 

A.D.M.S. Bristol. 

A.D.M.S. Netley and Southampton. 

A.D.M.S. Oxford. 

A.D.M.S. Dorset (Weymouth). 

Western. D.D.M.S. and Headquarters Staff. 
A.D.M.S. Preston. 
A.D.M.S. Manchester. 
A.D.M.S. Shrewsbury. 
A.D.M.S. Cardiff. 



TABLE OF WAR ORGANIZATION OF ADMINISTRATIVE 
MEDICAL SERVICES IN A COMMAND AT HOME. 






1 


1 


! 


1 


-M.S. 


* COMMAND 


MEDICAL CONTROLLER 


CONSULTING 


COMMAND 








SUROtONS 4 


INS^CCTINC 




SANITARY OFFICER 


Q.M.A.A.C. 


PHYSICIANS 


DCNTAL 


adminigtrfftio 

Questions 


1 ATTACHED OPFICIR 
II unitary questions. 


women's HosprtaM 4 
M quettions connected 

with Q.M.A.A.C. 
medical services 


IXSPECTOX8 Or 
HOSPITAL*. 

COMMAND 

MENTAL AMD 


LUPStON 

Inspection of 
dental asrv'cee. 




Inspections. 
Laboratories. 





INSPECTOR OF 










VOLUNTARY FIELD 






Schools of Sanitjrtic 


n. 


AMBULANCES. 





I 

I I 

* A.Ds.M.OF TRAVELLINB MEDICAL 

DISTRICTS. BOARDS. 
I-SPECIA.UST SANITARY OFFICER. Classification of r 

LATTArurn nrrirron "'' "? "*? d' 

(-ATTACHED OFFICERS. ff^ Ho.pit.1. 



"'' "? "*? d'chri(ed 
f 



Hospital dmim'stnition, Msdicxl Boards. R.A.M.C. psreonrml, 

accommodation, Claims. pcstinds, leave. 

equipment and Trsnsfsrs. conf.dentil reports. 

Medicol t Surgical Supplier Returns & distHbutio 

and of personnel. 

General questions Honoura t Rewards. 

redardintf disposal of Demobilization. 

sicV snd wounded. 



liacellansou 
questions. 



* Appointments marked with an asterisk existed in time of peace - = Travelling Medical Boards were 
represented in peace by a medical inspector of recruits The A.D.M.S. on the D.D.M.S. head- 
quarter staff was represented in peac* by an attached officer 

The above scheme did not apply to all Commands, but was modified according to the spec:al ad- 
ministrative requirements of ch - ft cume officially into -force after the arvnistice as a M'e 
Establishment . 



MaJby&Sons.Lith. 



ADMINISTRATION 67 

The headquarters staff of the D.D.M.S. varied somewhat 
in different commands, but owing to the continual growth of 
commands and opening up of new administrative areas it was 
not until 1919 that an official war establishment regulating the 
appointments made locally could be issued. The establishment 
of the office of a D.D.M.S. in a command was then authorized 
to consist, if necessary, of an A.D.M.S. with three D.A.D.sM.S., 
a command specialist sanitary officer, four attached officers, an 
inspecting dental officer, a medical controller of the Q.M.A.A.C., 
and an inspector of volunteer field ambulances. 

On the outbreak of war a Central Force for defensive 
and offensive operations in the event of invasion was concen- 
trated as an independent command, chiefly within the Eastern 
Command area. A deputy director of medical services* was 
appointed to the headquarters of the force in London ; and an 
A.D.M.S.f to each of the three armies and two mounted divisions 
of which the force was composed, in addition to the A.D.M.S. 
of each division of the armies. There was at first no clear 
definition of the responsibilities of the D.D.M.S. of the Central 
Force and the D.D.M.S. of commands regarding hospitals in 
which sick and wounded of the Central Force were treated, 
and an instruction was consequently issued in October, 1914, 
limiting the administrative responsibilities of the D.D.M.S. 
Central Force to the field medical units of divisions, medical 
personnel of units, and general sanitary supervision of the troops. 
When sick requiring hospital treatment were transferred from 
the field medical units to hospitals the responsibility of the 
D.D.M.S. Central Force ceased with regard to them. The 
general policy was to relieve the Central Force of responsibility 
as regards administrative services generally, but to give it every 
assistance from the administrative services of the command in 
which its troops were quartered. 

When Sir Ian Hamilton gave up the command of the Central 
Force to proceed to Gallipoli in March, 1915, any complications 
which may have existed regarding medical administrative 
responsibility disappeared, as the Central Force then ceased to 
be a separate command. It became part of the Eastern Com- 
mand and its entire medical administration was carried out by 
the D.D.M.S. of that command. A separate command with an 
administrative medical staff was formed, however, on Sir John 
French's return from France when he took command of the 
Home Forces in January, 1916. A director of medical services, 

* Surgeon-General J. G. MacNeece. 

f Colonels H. M. Sloggett (1st Army), F. J. Jencken (2nd Army), and J. C. 
Culling (3rd Army). 

(1735) F 2 



68 MEDICAL HISTORY OF THE WAR 

Surgeon-General Sir T. Galwey, was appointed to his head- 
quarters ; but his responsibilities were confined more or less to 
the consideration of schemes to meet all possible contingencies 
in the event of active operations taking place in the United 
Kingdom, while D.D.sM.S. of commands continued to exercise 
administrative medical control of hospitals and troops. 

Another directorate of medical services, outside the personal 
staff of the director-general, was the directorate of medical 
services for the reception and distribution of sick and wounded 
form overseas, of which an account is given in a separate 
chapter. The officer in charge of this directorate, Surgeon- 
General W. Donovan, was graded as a director of medical 
services for embarkation duties. 

The inspectorate of medical services was re-established on the 
1st March, 1918. Previous to this, however, a retired officer 
of the Army Medical Service, Surgeon-General W. S. M. Price, 
was appointed inspector of hospitals in April, 1915, with the 
object of bringing to the notice of the officers in charge of hospi- 
tals the names of all patients who at the time of his visit were 
considered fit to be discharged ; and when Surgeon-General 
Sir W. Babtie, who was nominally D.M.S. India and had been 
for some time acting as principal director of medical services 
in the Mediterranean, returned from Egypt in March, 1916, he 
was appointed a D.M.S. at the War Office with a view to making 
inspections in the United Kingdom on behalf of the director- 
general, chiefly in connection with the methods employed by 
recruiting medical boards in the different commands and by 
travelling medical boards in weeding out individual men and for 
hastening the return to duty with their units of men who were 
temporarily unfit for service in the field. On the 1st March, 
1918, he was definitely appointed inspector of medical services 
with the rank of Lieutenant-General. Major-General Sir M. W. 
Russell was at the same time appointed an assistant inspector 
of medical services chiefly with a view to investigating locally 
the complaints which were continually being sent to the 
Secretary of State for War, the director-general and other War 
Office officials from various sources regarding medical services. 
In fact, an officer, Surgeon-General W. W. Kenny, had been 
appointed for this purpose to the director-general's staff on the 
1st July, 1916, and continued to carry on these duties until he 
was replaced by Major-General Sir M. W. Russell in the beginning 
of 1918. At this time also several senior officers who had held 
administrative appointments in the expeditionary forces over- 
seas had been placed on the retired list on reaching the limit of 
age, and in order to take advantage of their services they were 
attached to each command as inspectors of hospitals to assist 



ADMINISTRATION 69 

the D.D.M.S.* This arrangement continued until October, 1918, 
when, in order to secure greater uniformity of method, it was 
arranged that the inspectors of hospitals should, in future, 
become deputy inspectors of medical services on Lieut. -General 
Sir W. Babtie's staff, although continuing to reside in the com- 
mands to which they were appointed. These appointments 
were made on the 24th October, 1918, but lapsed on the 1st 
May, 1919. They established a form of dual control in com- 
mands, which met with some criticism chiefly because an 
inspector in, but independent of, a command tended to cen- 
tralize in the War Office the work of administration of the 
command, crippled initiative in the command, and increased 
correspondence. The object, however, of the appointments was 
to attain a certain standard of uniformity in and co-ordination 
of the work of the various travelling medical boards in different 
commands, and it was understood that the system of War 
Office deputy inspectors was only to be of a temporary 
nature. 

The administration in the United Kingdom of the medical 
services of the Dominion Contingents and of United States 
medical services employed with the British Expeditionary 
Force in France was kept under separate control at their respec- 
tive headquarters in London ; but they were in close liaison with 
the director-general. Details of their administration are not 
available except in the case of the Canadian and South African 
medical services ; but they followed generally the war organiza- 
tion of the director-general's office. An officer of the United 
States Medical Corps was attached to the directorate of medical 
services at the War Office when U.S.A. base hospitals were 
established for British troops in France ; and this continued 
until June, 1919. In the case of Canada, Surgeon-General 
G. C. Jones became D.M.S. of Canadian Forces at their head- 
quarters in London at the beginning of the war, and was 
succeeded by Surgeon-General G. la F. Foster in 1917, with the 
grade of director-general. Surgeon-General Sir W. R. Howse 
acted in a similar capacity for the Australian Forces. 
The direction in London of the medical services of the New 
Zealand and South African Contingents was exercised by 
D.D.sM.S., Colonel W. H. Parkes being D.D.M.S. at the 
New Zealand headquarters, and Colonel A. B. Ward at South 
African Headquarters. 

In reviewing generally the administration of the medical 
services at home during the war, it may be said that both at the 

* Officers so appointed were : Major-Generals Sir H. R. Whitehead ; Sir 
C. P. Woodhouse ; R. Porter ; Sir F. H. Treherne ; B. M. Skinner ; and 
Colonels R. J. Geddes and C. W. R. Healy. 



70 MEDICAL HISTORY OF THE WAR 

War Office and in the commands it had to expand by a process 
of accretion rather than in accordance with any definite or pre- 
conceived plan. The effect in a way, the defect of this was 
apparent in the multitude and variety of Army Council Instruc- 
tions which were issued or cancelled from day to day, especially 
in connection with specialization in treatment of diseases and 
injuries and in the disposal of sick and wounded. The army 
medical administration, in fact, had many difficulties to contend 
with during these years in dealing with new experiences and 
new demands. Towards the end of the war and after, something 
definite emerged in connection with the administration of such 
special subjects as hygiene, pathology, and dentistry ; and in 
providing a better position for and recognition of such subjects 
as pharmacy and massage. Indeed, the general tendency in 
army medical administration by the time peace was declared 
was towards specialist administration of special subjects ; and 
the influence of this was felt throughout the whole of the 
medical services in the United Kingdom. It was inevitable 
that specialism should take a prominent part in the adminis- 
tration of the medical services at home. In the areas of 
military operations specialism in a professional sense was 
necessarily surrounded by difficulties and limitations, and it 
was only in the home hospitals that it could have full play. 



CHAPTER V 

HOSPITAL ACCOMMODATION IN THE UNITED KINGDOM 

BEFORE the war the accommodation in the military 
hospitals in the United Kingdom was approximately 7,000 
equipped beds,* of which some 2,000 were occupied. At the 
time of the Armistice the number of beds had increased 
to 364,133, including 18,378 for officers. 

This immense expansion of military hospital beds at home was 
effected in a variety of ways. Additions were made to existing 
military hospitals, the territorial force general hospitals were 
opened and enlarged, new military hospitals were constructed 
or installed in existing buildings, special war hospitals were 
established in asylums, poor law institutions and other public 
buildings, civil hospitals allotted beds to military patients, 
and a large number -of auxiliary hospitals was prepared by 
voluntary effort throughout the country. 

From the very commencement of the war the Local Govern- 
ment Board, the Board of Control, the Board of Education, 
the governing bodies of civil hospitals, the British Red Cross 
Society, the Order of St. John, the Soldiers' and Sailors' Help 
Society, municipal bodies, and private individuals co-operated 
with the Army Medical Service and gave invaluable assistance 
to it in expanding the hospital accommodation for the sick 
and wounded from overseas and from camps and garrisons in 
the United Kingdom. 

The number of military hospitals at home before the war was 
between 150 and 160,f but some of them were more or less 
obsolete and unequipped. The largest and most important 
were the Royal Victoria Hospital, Netley, with 955 beds, the 
Herbert Hospital, Woolwich, with 629 beds, and the Cam- 
bridge and Connaught Hospitals, Aldershot, with 492 and 
472 beds respectively. Only six others, the Queen Alexandra's 
Military Hospital in London, King George V Hospital in Dublin, 
the Alexandra Hospital at Cosham, and the Military Hospitals 
at Devonport, Colchester, and the Curragh had 200 beds or 

* The actual accommodation in military hospitals was for some 9,000 beds, 
but a considerable number of the beds was not equipped, and in some cases 
the accommodation had been appropriated for other purposes. 

f If families' hospitals and hospital buildings appropriated for other 
purposes are added to this number, there would have been over 200 hospitals. 

71 



72 MEDICAL HISTORY OF THE WAR 

more. Seven other military hospitals had less than that number 
of beds but more than 100. The majority of the military hos- 
pitals were small garrison or depot hospitals, about 90 of them 
with only ten beds or less. 

Measures were initiated at the War Office for the expansion 
of these hospitals on the 31st July, 1914, when the commands 
were asked to report on the extent to which the larger hospitals 
could increase their accommodation. This was followed by a 
general instruction, issued on the 10th August, for the opening 
up of all the military hospitals in the United Kingdom 
to their fullest extent by the appropriation of such 
government buildings as were available in the immediate 
neighbourhood, and resulted in 562 beds being added to the 
larger hospitals in August, 1,290 in September, 1,342 in October, 
1,221 in November, and 814 in December, or a total of 5,229 
by the end of 1914. The smaller hospitals were also expanded 
to a greater or less extent during these months. About half of 
the additional accommodation was obtained in huts, and the 
remainder in various buildings or hospital marquees. Alto- 
gether the accommodation in the existing military hospitals 
increased to 26,982 beds during the war. The greatest pro- 
portionate increase was in the Western Command from 336 to 
1,794 beds, in the Eastern from 1,609 to 7,258, and in the 
Southern from 2,032 to 8,409. The Western Command before 
the war had no large military hospitals but had a number of 
small depot or garrison hospitals. Other commands doubled 
or trebled their existing military hospital accommodation. 

The twenty-three territorial force general hospitals as 
already noted were mobilized at once. They were organized for 
520 beds, but expanded to an even greater extent than the 
existing military hospitals by appropriating additional buildings, 
chiefly schools and poor law premises, in localities often widely 
apart.* The two new general hospitals (the 2nd line of the 
1st Southern General Hospital at Birmingham, and the 5th 
London General Hospital in St. Thomas's Hospital) which were 
opened during 1915 added to the accommodation. No limit 
appears to have been set on the extent to which some territorial 
force general hospitals could be enlarged, especially in the 
Western Command, where they became units of an exceptionally 
extensive character. In the case of the 2nd Western General 
Hospital, for example, the original 520 beds expanded from one 
public building to another in the city of Manchester and its 

* In some instances sections were opened in towns many miles away from 
the main section of the hospital. For example, there was a section of the 
1st Southern General Hospital at Stourbridge, with the main section of the 
hospital in Birmingham. 



HOSPITAL ACCOMMODATION 73 

suburbs until at one time, in August, 1917, it consisted of a 
hospital of 6,700 beds, scattered over 34 different premises, the 
majority being schools, each with accommodation for 100 to 
200 beds or more. 

The territorial force general hospitals thus expanded from 
the normal total of 11,960 beds for which provision had been 
made before the war to 48,234 beds by the end of 1917. This 
expansion did not take place as rapidly after mobilization as 
in the case of the existing military hospitals, but as many as 
16,702 beds were ready by the end of 1914. 

These territorial force general hospitals were maintained 

id equipped by Territorial Force County Associations until 
Lpril, 1917, when the military ordnance authorities in each 
;ommand became responsible for their equipment and the 
procedure for maintenance and equipment then became the 
ime as for other military hospitals. The original method of 
equipping them was by contracts entered into with various 
local firms during peace, and appears to have worked well and 
ensured rapid mobilization. But eventually there was much 
confusion with regard to equipment, especially in the case of 
those widely expanded hospitals in the Western Command to 
which reference has already been made. 

Most of the territorial force general hospitals opened in 
educational premises, but some were fortunate in being able to 
establish themselves in magnificent new hospitals ; the 4th 
London General Hospital, for example, found accommodation 
in the new King's College Hospital, Denmark Hill, the 1st 
Western in the new municipal fever hospital at Fazakerly, 
outside Liverpool. Others, such as the 3rd and 4th Scottish, 
had new poor law institutions provided for them. The 5th 
Northern General Hospital opened originally in a large disused 
asylum, but extended into a fine new poor law hospital, fully 
equipped, at North Evington, Leicester. When expansion 
took place, it was usually carried out by taking over other 
schools, asylums, or poor law premises, and then the necessary 
works and services were carried out by the authorities to whom 
the premises belonged. 



74 



MEDICAL HISTORY OF THE WAR 



The following table shows the nature of the accommodation 
in the various territorial force general hospitals : 



Designation. 


Hospital beds 
in 1917. 


Locality. 


Buildings, etc. 


Offrs. 


O. ranks 


1st Eastern . . 


153 


1,020 


Cambridge . . 


Leys Schools and Trinity 










College Buildings subse- 










quently hutted hospital. 


2nd Eastern . . 


45 


1,204 


Brighton 


Four Council Schools and 










three private houses. 


1st London . . 


231 


1,390 


Camberwell. . 


St. Gabriel's College for 










Ladies, L.C.C. Schools, 










beds in three civil hospi- 










tals (Bart.'s, National 










Hospital, and London 










Temperance Hospital) , 










and huts in Myatt's Park. 


2nd London . . 


170 


1,352 


Chelsea 


St. Mark's College, one 










L.C.C. Secondary School, 










and beds in four civil 










hospitals (Central Lon- 










don, Freemasons', Great 










Northern, St. Andrew's). 


3rd London . . 


897 


1,503 


Wandsworth 


Royal Victoria Patriotic 










Schools and huts, with 










beds in eight civil hospi- 










tals (Bolingbroke Hospi- 










tal, Hospital for Epilepsy 










and Paralysis, Middlesex 










Hospital, Royal Hospital, 










St. Mary's Hospital, 










Throat Hospital, West 










End Hospital, Weir 










Hospital). 


4th London . . 


478 


1,693 


Denmark Hill 


Part of King's College 










Hospital ; Civil Asylum, 










Maudsley ; beds in Ita- 










lian, Poplar and West 










London Hospitals ; huts 










and marquees in Ruskin 










Park; two L.C.C.Schools, 










one private house. 


5th London . . 


62 


600 


Lambeth . . 


Part of St. Thomas's Hospi- 










tal and huts, and in Red 










Cross Hospital. 


1st Northern . . 


113 


2,053 


Newcastle . . 


Armstrong College of 










Science, private house. 










and Newcastle-on-Tyne 










Workhouse Infirmary. 


2nd Northern 


64 


1,720 


Leeds 


Leeds Educational College, 










and Beckett'sPark, Leeds. 



HOSPITAL ACCOMMODATION 



75 



Accommodation in the various Territorial Force General Hospitals cont. 



Designation. 


Hospital beds 
in 1917. 


Locality. 


Buildings, etc. 


Offrs. 


O. ranks 


3rd Northern . . 


58 


2,230 


Sheffield . . 


Collegiate Hall Training 










College, Collegiate School, 










six schools, three infirm- 










aries, three civil hospitals 










(Royal, Oakbrook, Ran- 










moor), one private house. 


4th Northern . . 


36 


1,364 


Lincoln 


The Lincoln School and 










hutments in the playing 










fields. 


5th Northern . . 


110 


2,527 


Leicester 


Old County Mental Hospi- 










tal.extended by hutments, 










and North Evington War 










Hospital (Poor Law In- 










stitution) . 


1st Scottish . . 


34 


1,385 


Aberdeen . . 


Four City of Aberdeen 










School Board's Schools 










(Girls' High, Central, 










Rosemount, Westfield), 










and Poorhouse with 










added huts and tentage. 


2nd Scottish . . 


30 


1,002 


Edinburgh . . 


Craigleith Poorhouse. 


3rd Scottish . . 





1,163 


Glasgow 


Glasgow Parish Hospital, 










Stobhill. 


4th Scottish . . 





1,180 


Glasgow 


Glasgow Parish Hospital, 










Stobhill. 


1st Southern . . 


68 


3,464 


Birmingham. 


Birmingham University, 










two school premises 










(King's Heath and Stirch- 










ley), part of Monyhull 










Colony for Epileptics, 










Stourbridge Infirmary. 


2nd/ 1st Southern 





1,800 


Birmingham 


Dudley Road Infirmary and 










billets. 


2nd Southern.. 


200 


1,742 


Bristol 


Poor Law Infirmary (King 










Edward VII wing). 










Redmaids Secondary 










School, Poor Law Insti- 










tution, Southmead, and 










private house (Bishop's 










Knoll). 


3rd Southern.. 


262 


1,351 


Oxford 


Examination Schools and 










Annexe and Masonic 










Buildings, two civil 










hospitals (Radcliffe In- 










firmary and Oxford Eye 










Hospital), Town Hall, 










College Shelter, three Col- 










lege Buildings (Durham, 










Radcliffe, Somerville 










Ladies' College), and Cow- 










ley Workhouse. 



76 MEDICAL HISTORY OF THE WAR 

Accommodation in the various Territorial Force General Hospitals cont. 



Designation. 


Hospital beds 
in 1917. 


Locality. 


Buildings, etc. 


Offrs. JO. ranks 


4th Southern 


193 


1,248 


Plymouth . . 


Poor Law Buildings, three 










schools (Camel's Head, 










Hyde Park, Salisbury 










Road), Civil Hospital (S. 










Devon and E. Cornwall), 










private house, and Mutley 










Barracks. 


5th Southern 


38 


1,108 


Portsmouth 


Municipal secondary school. 










Poor Law Infirmary, and 










section of civil Hospital 










(Royal Infirmary). 


1 st Western . . 


120 


3,396 


Liverpool . . 


Civil Hospital, 11 schools. 










Tropical School of Medi- 











cine, Wallasey Town Hall. 


2nd Western . . 


.433 


4,409 


Manchester. . 


Municipal Central School, 










22 school premises, Town 










Hall, Poor Law Infirm- 










ary, and subsequently, 










in 1918, twelve hundred 










beds under canvas in 










the University Athletic 










Grounds. 


3rd Western . . 


39 


2,496 


Cardiff 


Five school premises, two 










partly used civil hospitals. 










(Bedford House and King 










Edward VII), twoL.G.B. 










premises and cavalry 










Barracks. 



In October, 1914, hutted camps were being constructed 
for the New Army troops at Witley and Bramshot in the 
Aldershot Command, at Shorncliffe, Seaford and Harwich in 
the Eastern Command, at Cromarty and Invergordon in the 
Scottish Command, at Berehaven in Ireland, and in the Wylye 
Valley, near Salisbury, in the Southern Command. Hutted 
camps were subsequently formed at other training centres 
in the United Kingdom. At first no provision was made for 
fully equipped hospitals in these camps. Only small detention 
hospitals, usually in one or more hospital marquees, were 
provided, and sick requiring hospital treatment had to be 
transferred to the nearest military, territorial force, or civil 
hospital. In some cases the hospital was at a considerable 
distance from the camp. For example, sick from the training 
centre at Tring were transferred to one of the London terri- 
torial force general hospitals, a distance of over 30 miles. 
Hutted hospitals were afterwards constructed in connection 



HOSPITAL ACCOMMODATION 



77 



with hutted camps on a scale of beds that was comparatively 
small in proportion to the number of troops for which provision 
was being made. No definite scale appears to have been laid 
down, but it apparently varied from 1 to 2| per cent, of the 
strength ; so that in the larger camps such as those in the 
Salisbury Plain area, hospitals of considerable size were con- 
structed and many of them were eventually expanded by tent- 
age. But several new military hospitals were opened in various 
other localities to meet local requirements, more especially the 
requirements of coast defences and smaller garrisons. These 
new military hospitals, including the hutted hospitals in new 
hutted camps, added approximately 47,500 beds to the hospital 
accommodation in the United Kingdom. The following table 
indicates the distribution and accommodation in the hutted 
hospitals : 



Command. 


Hospital beds. 


Designation. 


Nature of 
buildings, etc. 


Offrs. 


O. ranks 


Aldershot . . 


_ 


688 


Bramshot Military 


Huts Canadians. 








Hospital. 









700 


Wokingham Convales- 


Canadian Convales- 








cent Hospital. 


cent Hospital. 







450 


Frensham Hill Mili- 


Huts. 








tary Hospital. 




Eastern 





120 


Princess Christian Mili- 


Hutted Hospital. 








tary Hospital, Engle- 










field Green. 









140 


Sandwich Military 


Huts and Depot of 








Hospital. 


R.E. Inland Water- 










way and Docks 










Department. 







107 


Thetford Military 


New Hutted Hospital. 








Hospital. 









750 


Warlingham Military 


Hutted Hospital. 








Hospital. 




Northern . . 





1,000 


Brocton Camp P/w 


Camp huts. 








Hospital. 






26 


724 


Rugeley Camp Mili- 


Hutted Hospital. 








tary Hospital. 






25 


645 


Catterick Military 


Hutted Hospital. 








Hospital. 






18 


338 


Clipstone Camp Mili- 


Hutted Hospital. 








tary Hospital. 






13 


607 


Grantham Military 


Hutted Hospital. 








Hospital. 






18 


754 


Lichfield Central 


Camp huts near bar- 








Hospital. 


racks. 




25 


645 


Ripon Military 


Hutted Hospital. 








Hospital. 




Scottish . . 


20 


206 


Cromarty Military 


Hutted Hospital. 








Hospital. 





78 MEDICAL HISTORY OF THE WAR 

Distribution and Accommodation in Hutted Hospitals cont. 



Command. 


Hospital beds. 


Designation. 


Nature of 
buildings, etc. 


Offrs. JO. ranks 


Southern . . 


11 


1,261 


Button Veny Military 


Hutted Hospital. 








Hospital. 









119 


Swanage Military 


Hutted Hospital. 








Hospital. 









1,040 


Canadian Red Cross 


Hutted Hospital. 








Hospital, Taplow. 






20 


165 


Wareham Military 


Hutted Hospital. 








Hospital. 









105 


Hazeley Down Military 


Hutted Hospital. 








Hospital, Winchester. 









357 


Hursley Park Military 


Hutted Hospital. 








Hospital, Winchester. 






10 


238 


Magdalene Camp Mili- 


Hutted Hospital. 








Hospital, Winchester. 






20 


268 


Bovington Camp Mili- 


Hutted Hospital. 








tary Hospital, Wool. 









99 


Blandford Military 


Hutted Hospital in 








Hospital. 


camp. 




24 


1,120 


Chiseldon Camp Mili- 


Hutted Hospital and 








tary Hospital. 


camp huts. 




100 


1,189 


Brockenhurst Military 


Hutted Hospital for 








Hospital. 


Indians and New 










Zealanders, with 










some hotels added. 




10 


980 


Codford Military 


Hutted Hospital for 








Hospital. 


New Zealanders. 







1,265 


Eastleigh Military 


Hutted Camp and 








Hospital. 


school buildings. 




11 


1,379 


Fargo Military 


Hutted Hospital and 








Hospital. 


tentage. 




21 


588 


Fovant Military 


Hutted Hospital. 








Hospital. 




Vestern 





50 


Bettisfield Park Mili- 


Hutted camp hos- 








tary Hospital. 


pital 







1,290 


Kimnel Park Military 


530 beds Hutted Hos- 








Hospital, Rhyl. 


pital extended by 










canvas. 







3,116 


Oswestry Military 


Hutted Hospital for 








Hospital. 


400. Camp huts. 










Additional ward 


i 






huts and canvas 










for p/w. 







730 


Frees Heath Military 


409 beds Hutted Hos- 








Hospital, Shrop- 


pital and camp huts. 






shire. 





Another and important class of hospital was the class 
designated " war hospitals." The term was originally intended 
for hospitals which were being opened in asylums belonging to 
the Board of Control under certain agreements with the War 
Office, but soon others, opened in poor law infirmaries or other 
buildings by local committees, were also designated war 
hospitals, though not strictly such. Many of these institutions 



HOSPITAL ACCOMMODATION 79 

were offered by the Government departments concerned 
immediately after war was declared, the general conditions of 
the agreement being that the War Office should meet the cost 
of adaptation, repairs, reinstatements, compensation to dis- 
placed staff, rates, taxes, fuel and lighting, and expenditure 
incurred in moving inmates elsewhere or in additional cost for 
their maintenance ; also that the superintendent of the institu- 
tion should be granted a temporary commission in the R.A.M.C. 
and take command of and administer the hospital, and that 
the asylum or infirmary staff should be retained for such duties 
in the hospital as they were accustomed to perform in their 
civil capacity. The staff was, however, supplemented by 
R.A.M.C. and military nursing personnel as required, and 
a regular R.A.M.C. officer was usually appointed for duty as 
registrar and as general assistant to the administrator for the 
purpose of maintaining records and discipline. This was the 
general principle governing the staff of war hospitals, but in 
some cases a regular R.A.M.C. officer or retired officer of the 
Army or Indian Medical Service was placed in command. 
The arrangements worked satisfactorily in most cases, 
notwithstanding the fact that the asylum officers in charge 
were without experience of military hospital administration 
and were obliged to carry out duties with which they were 
unfamiliar. It was this method of expanding hospital accommo- 
dation on which most reliance was placed in the later stages 
of the war. It was continued until demobilization set in ; more 
and more institutions being taken up as the war went on and 
increase of accommodation became urgent. Asylums and poor 
law institutions were vacated by concentrating the inmates 
into a smaller number of asylums and institutions, or by board- 
ing them out. Several municipal committees organized war 
hospitals, on somewhat similar conditions, in poor law premises 
or municipal buildings, but in some localities, such as Bath and 
Huddersfield, municipal committees constructed hutted hospi- 
tals as local war hospitals. By the end of 1917, the war 
hospitals provided approximately 53,500 beds. The number 
increased to some 58,000 by the end of the war. 

Asylums and poor law infirmaries, especially those constructed 
in more recent times, proved ideal buildings for war hospital 
purposes, as not only had they ample and attractive pleasure 
grounds and gardens, recreation fields, recreation halls and well- 
equipped stages for concerts and theatricals ; but they were 
also going concerns with ample stores and kitchens, water, 
steam, light and electricity supply, and in fact all the resources 
of large hospital institutions. 

Negotiations for taking over asylums were commenced early 



80 



MEDICAL HISTORY OF THE WAR 



in the war ; so that by March, 1915, nine large institutions were 
being vacated in order to become war hospitals. The use of 
poor law institutions was less clearly denned at the beginning 
of the war, because many of them were taken over by territorial 
force general hospitals either as their original headquarters or 
for purposes of expansion. It was only at a later stage that 
they became independent war hospital units. The following 
two tables show the more important of the hospitals in asylum 
and poor law premises. 

War Hospitals established in Asylums and Metropolitan 
Asylums Board Fever Hospitals. 



Designation. 


Hospital beds. 


Government 
Department. 


Locality. 


Institution. 


Offrs. 


O. ranks. 


Crowthorne War 





48 


Home Office 


Broadmoor 


Asylum for criminal insanes 


Hospital. 










used for mental cases 












amongst p/w. 


Craylingwell War 





1,040 


Board of 


Chichester .. 


Asylum. 


Hospital . 






Control. 






Dartiord War 


48 


1,034 


Metropolitan 


Dartford . . 


Permanent fever hospital 


Hospital. 






Asylums Board 




hutments used as p'w 












hospital. 


Northamptonshire 





965 


Board of 


Duston 


Asylum. 


War Hospital. 






Control. 






Horton (County of 


64 


2,462 





Epsom 


Asylum. 


London) War Hos- 












pital. 












Manor (Countyof Lon- 





1,179 


,, 


,, 


Asylum. 


don) War Hospital 












Ewell (County of 





230 








Epileptic colony. 


London) War Hos- 












pital. 












County of Middlesex 





1,520 





Napsbury, St. 


County asylum. 


War Hospital. 








Albans. 




Norfolk War Hospital. 


20 


1,971 


( , 


Thorpe, 


County asylum (500 beds 










Norwich. 


added in 1918 in mar- 












quees). 


Maudsley Neurological 





200 





Denmark Hill 


Maudsley Memorial Hospi- 


Hospital. 










tal. 


Brook War Hospital 


24 


890 


Metropolitan 


Woolwich .. 


Fever hospital. 








AsylumsBoard 






Belfast War Hospital. 





500 


Belfast 


Belfast 


Belfast civil asylum. 








Corporation. 






Richmond War 





32 


Dublin 


Dublin 


Richmond district asylum, 


Hospital. 










Dublin. 


Springfield War 





225 


Board of 


Wandsworth 


Annexe of Middlesex county 


Hospital. 






Control. 




asylum. 


Gateshead War 





437 


Jf 


Stannington 


Gateshead borough asylum 


Hospital. 










(opened August, 1918). 


Northumberland War 


33 


1,448 


ft 


Newcastle-on- 


City lunatic asylum, with 


Hospital. 








Tyne. 


tentage and shelters. 


Wharncliffe War 





1,894 


I( 


Sheffield . . 


Asylum. 


Hospital. 












Edinburgh War 


55 


2,571 


Board of Con- 


Bathgate . . 


New asylum buildings, 


Hospital. 






trol, Scot- 




Bangour. 








land. 






"Whittingham Military 





700 


Board of 


Whittingham 


Lancashire county asylum 


Hospital. 
Murthly War 


_ 


350 


Control. 
Board of Con- 


Murthly . . 


(opened April, 1918). 
Asylum building. 


Hospital. 






trol, Scot- 












land. 






Dykebar War 





500 





Paisley 


Asylum. 


Hospital. 












1st Birmingham War 





1,000 


Board of 


Rednal, near 


Rubeny Hill asylum. 


Hospital. 






Control. 


Birmingham. 




2nd Birmingham War 


16 


911 


M 


Northfl eld, near 


Hollymoor asylum. 


Hospital. 








Birmingham. 




Beaufort War Hospital 


25 


1,578 


N 


Fishponds, 


Asylum. 










near Bristol. 





HOSPITAL ACCOMMODATION 81 

War Hospitals established in A sylums and Metropolitan A sylums Board 
Fever Hospitals cont. 



Designation. 


Hospital beds. 


Government 
Department. 


Locality. 


Institution. 


Offrs. 


O.ranks. 


Ashhurst War 




580 


Board of 


Littlemore . . 


Oxford County and City 


Hospital. 






Control. 




asylum. 


4th Canadian General 





1,750 





Basingstoke 


Hampshire 2nd county 


Hospital. 










asylum, Park Prewett. 


Maghull Red Cross 


37 


500 


,, 


Liverpool . . 


New asylum and private 


Hospital. 










house. 


Lord Derby War 





3,000 





Warrington . . 


Large asylum (Lancashire 


Hospital. 










county, with tentage). 


Welsh Metropolitan 


45 


1,155 


,, 


Whitcburch, 


Asylum. 


War Hospital. 








near Cardiff. 




Queen Mary's Military 





2,110 


,, 


Whalley . . 


New asylum. 


Hospital, Whalley. 












Grove Military Hospi- 


60 


940 


Metropolitan 


Tooting 


Fever hospital. 


tal, Tooting. 






Asylums Board 






Notts County War 





540 


Board of 


Radclifie-on- 


Asylum. 


Hospital. 






Control. 


Trent. 




U.S.A. Base Hospital 





1,300 


.- 


Milton 


Portsmouth borough asy- 


No. 33. 










lum (opened Aug., 1918). 



Hospitals in the more important Poor Law premises, exclusive 
of those occupied by Territorial Force General Hospitals. 



Designation. 


Hospital beds. 


Government 
Department. 


Locality. 


Institution. 


Offrs. 


O. ranks. 


Guildford War 




445 


Guildford 


Guildford . . 


Poor law institution. 


Hospital. 






Guardians. 






Belmont P/w Hospital. 


92 


1,175 


Metropolitan 


Belmont, 


Poor law institution. 








AsylumsBoard 


Surrey. 










(Fulham Board 












of Guardians). 






Bradford War 





1,174 


Municipal 


Bradford . . 


Poor law infirmary (part 


Hospital. 






Committee. 




occupied), new buildings, 












schools and city hospital. 


Halifax War Hospital. 





702 


Halifax 


Halifax 


Two poor law infirmaries 








Guardians. 




(part occupied of one). 


Keighley War Hospital. 





720 


Keighley and 


Keighley . . 


New civil fever hospital. 








Bingley Joint 












HospitalBoard, 












L.G.B. 






East Leeds War 





1,895 


L.G.B. and 


East Leeds . . 


Two poor law institutions, 


Hospital. 






Education Au- 




schools and parochial 








thorities Local 




hall. 








Committee. 






Stoke-on-Trent War 





711 


L.G.B. 


Newcastle- 


Poor law premises. 


Hospital. 








under-Lyme. 




Bagthorpe War 





2,021 


L.G.B. and 


Nottingham 


Poor law infirmary, Bag- 


Hospital. 






Education Au 




thorpe, and schools. 








thorities. 






Sunderland War 





500 


Sunderland 


Sunderland. . 


Highfield hospital, poor law 


Hospital. 






Guardians. 




infirmary with hutted 












extension. 


Dundee War Hospital 


6 


462 


Poor Law . . 


Dundee 


Poor law institution. 


Perth War Hospital 





100 


Parish Council 


Perth 


Poor law institution. 


Merryflats War 





488 





Govan 


Part of poor law institution. 


Hospital. 












Oakbank War 





250 




Glasgow 


Poor law institution. 


Hospital. 












LeithWar Hospital. . 


165 


420 


n >i 


Leith 


Poor law infirmary. 


Crookston War 





350 


tt i 


Nitshill 


Poor law institution. 


Hospital. 












Reading War Hospital 


106 


1,573 


L.G.B. Educa- 


Reading . . 


Poor law infirmary, schools, 








tional. 




public buildings. 


Fusehill War Hospital 





650 


L.G.B. 


Carlisle 


Poor law hospital, two 












schools. 


Chester War Hospital 





650 


)( 


Chester 


Poor law infirmary. 


Ashton-under-Lyne 





250 


> 


Ashton-under- 


Poor law hospital. 


Lake Hospital. 








Lyne. 




Tranmere Auxiliary 





350 


tj 


Birkenhead . . 


Poor law hospital. 


Hospital. 













(1735) 



82 



MEDICAL HISTORY OF THE WAR 



Hospitals in the more important Poor Law premises, exclusive of those occupied 
by Territorial Force General Hospitals cont. 



Designation. 


Hospital beds. 


Government 
Department. 


Locality. 


Institution. 


Offrs. 


O. ranks. 


Queens Park Auxiliary 


__ 


200 


L.G.B. 


Blackburn . . 


Poor law hospital. 


Hospital. 












Townleys Hospital . . 





560 




Boltoa 


Poor law hospital. 


Primrose Bank 





330 


Jt 


Burnley 


Poor law hospital. 


Hospital. 












Griffithstown Auxiliary 





301 




Griffithstown 


Poor law hospital. 


Hospital. 












Alderhey Hospital . . 


32 


830 


(f 


Liverpool . . 


New poor law infirmary. 


Belmont Road 





950 


ff 





Poor law infirmary, in- 


Hospital. 










creased to 2,000. 


Highfield Hospital . . 





510 





_. 


Poor law infirmary. 


Mill Road Auxiliary 





700 








Poor law infirmary. 


Hospital. 












Dearnley Hospital . . 





800 





Rochdale . . 


Part of poor law hospital. 


Hope Hospital 





431 


JJ 


Salford 


Part of poor law hospital. 


Steppinghill Hospital 
VVhitecross Auxiliary 





500 
509 


" 


Stockport . . 
Warring ton. . 


Part of poor law hospital. 
Part of poor law hospital. 


Hospital. 












Berrington War 





520 





Shrewsbury 


Poor law infirmary. 


Hospital. 












Kitchener Military 


76 


1,624 


n 


Brighton . . 


Poor law infirmary. 


Hospital. 












Edmonton Military 





1,810 


tt 


Edmonton . . 


Poor law infirmary. 


Hospital. 












Bangor Military 





200 


(1 


Bangor 


Poor law infirmary. 


Hospital. 












Nell Lane Military 





3,284 


Manchester 


West 


Poor law hospital. 


Hospital. 






Guardians. 


Didsbury. 




Richmond Military 





514 


L.G.B. 


Richmond . . 


Poor law institution. 


Hospital. 












Southwark Military 





783 


,, 


East Dulwich 


Poor law infirmary. 


Hospital. 












Tooting Military 





712 


,, 


Tooting 


Poor law institution. 


Hospital. 













Bermondsey Military 





796 


,, 


Bermondsey 


Poor law workhouse. 


Hospital. 












Bethnal Green Military 





729 




Bethnal Green 


Poor law infirmary (with 


Hospital. 










beds in London Hospital). 


City of London Mili- 


14 


713 




Lower 


Poor law infirmary. 


tary Hospital. 








Clapton. 




Endell Street Military 





573 




Endell Street, 


St. Giles infirmary. 


Hospital. 








W.C. 




Fulhain Military 





1,130 


H 


Hammersmith 


Parish of Fulham infirmary. 


Hospital. 












Hampstead Military 
Hospital. 





788 





Hampstead 


Mount Vernon hospital, 
Haverstock Hill hospital, 












and New End poor law 












infirmary. 


Holborn Military 





954 


M 


Mitcham 


Poor law institution. 


Hospital. 












Lewisham Military 


24 


838 




Lewisham . . 


Poor law institution. 


Hospital. 












Mile End Military 





864 


,, 


Mile End . . 


Poor law institution. 


Hospital. 












Military Orthopaedic 


30 


1,070 




Shepherds 


Hammersmith infirmary 


Hospital, Shepherds 








Bush. 


and workhouse. 


Bush. 













The accommodation for military patients in civil hospitals 
varied very much both in numbers and in importance. In 
certain cases complete hospitals were placed at the disposal of 
the military authorities. In others, a definite number of beds 
was allotted for sick and wounded soldiers in special wards ; 
while in others, again, the number of beds was indefinite and 
military patients were admitted to the general wards according to 



HOSPITAL ACCOMMODATION 83 

the accommodation available. The War Office had been warned 
by the experience of the South African War not to place reliance 
on expanding military hospital accommodation by means of the 
civil hospitals to any great extent. It was obvious that the 
needs of the civil population demanded the full use of these 
hospitals. The experience of the South African War was 
repeated during the war of 1914-18. At the same time the 
governing bodies of civil hospitals did everything in their 
power, compatible with their obligations to the sick and in- 
jured of the poorer classes, to assist in providing additional 
hospital accommodation for military patients. The beds ob- 
tained in this way totalled some 16,000 during the war, the 
majority being available immediately after war was declared. 
Military patients admitted to civil hospitals were treated and 
nursed by the hospital staff in the same way as civil patients, 
the military authorities paying a capitation grant to the hospital 
of four shillings daily* for each military patient. A number of 
these civil hospitals, especially in London, were sections of 
military or territorial force general hospitals for purposes of 
discipline, maintenance of records and final disposal of their 
military patients, or they were affiliated to them for adminis- 
trative control. Practically none of them were independent 
military units. 

Civil isolation hospitals were generally used for military 
patients suffering from acute infectious diseases, who were 
admitted under the same conditions as civil patients ; the War 
)ffice paying a capitation grant of six shillings daily for each 
military patient.f Where the accommodation was insufficient 
the War Office arranged with local sanitary authorities to 
have additional pavilions or huts constructed on sites adjacent 
to or in the grounds of the existing hospitals. 

A very large proportion of the 364,133 beds obtained 
during the war was in hospitals established and equipped 
by voluntary aid organizations and private individuals. 
Hospitals of this kind were offered in large numbers 
from the time war was imminent, and in every part 
)f the country. Their variety and character were almost 
is great as their number. In accordance with the Field 
krvice Regulations all voluntary offers of assistance in aid 
)f the sick and wounded made in the United Kingdom 
)n the outbreak of war or during the progress of hostilities, 
other than those coming from the ambulance departments of the 
>der of St. John and the St. Andrew's Ambulance Association 

This rate remained unaltered until February, 1918, when it was raised 
to four shillings and ninepence. 

t In special cases a maximum of seven shillings was allowed. 
(1735) G 2 



84 MEDICAL HISTORY OF THE WAR 

for the provision of personnel, had to be submitted in the 
first instance to the British Red Cross Society and communi- 
cated by it to the Army Council if they were likely to be of 
practical value. Numerous offers, however, came to the War 
Office direct, and much embarrassment was caused in the earlier 
stages of the war by the refusal of several of the donors to 
place themselves in the first instance in the hands of the British 
Red Cross Society to which they were referred by the War 
Office authorities in accordance with the regulations on the 
subject. The administrative medical services consequently had 
to face the dilemma either of refusing important means of 
expanding hospital accommodation or of ignoring their own 
regulations. To meet this difficulty in dealing with questions 
of expansion of hospital accommodation a representative of 
the British Red Cross Society attended at the War Office for the 
purpose of consulting the army medical department regarding 
the suitability of offers of private hospitals.* 

Certain voluntary hospitals were offered by influential com- 
mittees, representing several subscribers or public bodies, with 
a view to their joining the expeditionary force in France. 
With regard to hospitals of this kind, the policy of the War 
Office was to encourage them to establish themselves in suitable 
localities in England ; or to consent to be placed alongside 
military hospitals at home as a means of expanding the latter, 
until such time as it was possible for the military authorities in 
France to accept them for service overseas. Important addi- 
tions were thus made, especially to the accommodation at the 
Royal Victoria Hospital, Netley, where the British Red Cross 
Society and a Welsh committee each constructed excellent 
hutted hospitals in its grounds. 

Throughout the country large and small hospitals, some 
1,600 in number and varying from 6 to 200 or more beds, 
w r ere accepted chiefly through the Joint War Committee of the 
British Red Cross Society and Order of St. John.f Most 
of these hospitals were opened and staffed by local volun- 
tary aid detachments ; and, although the accommodation in 
some of them was not large, they were regarded as of immense 
importance in offering to those who had no other means of 
doing so the opportunity of helping in the work of the war and 
of coming into close touch and sympathy with the sick and 



* At first Mr. G. H. Makins represented the British Red Cross Society, 
and on his joining the expeditionary force as consulting surgeon in September, 
1914, Mr. Fox'Symons took his place. 

f The number of hospitals from which the Joint War Committee obtained 
returns was 753 in 1915, 960 in 1916, 1,073 in 1917 and 1,014 in 1918. These, 
however, did not include voluntary hospitals in Scotland. 




HOSPITAL ACCOMMODATION 85. 

wounded.* This and other considerations, such as the need of 
employing civil medical practitioners in their own civil prac- 
tices, counterbalanced the disadvantages of having hospital 
accommodation scattered throughout the country in innumer- 
able small hospital units instead of being concentrated in a few 
large units. In one or two localities, as, for example, at Exeter 
and Cheltenham, local groups were formed under central admin- 
istration, thus materially removing some of the defects inherent 
in having numerous small hospitals administered separately.! 

The voluntary hospitals were designated auxiliary hospitals 
and received, or were entitled to receive, a War Office capitation 
grant for each military patient admitted to them. The capita- 
tion grant varied according to the facilities for treatment. 
Those with a trained nursing personnel and suitable equip- 
ment were designated Class A auxiliary hospitals, and those 
suitable only for reception of convalescents requiring little or 
no hospital treatment were designated Class B auxiliary hospi- 
tals. In the earlier months of the war this classification did 
not exist, as the Class B auxiliary hospitals were registered as 
convalescent homes to which military patients could be dis- 
charged from hospital on sick furlough. The term " convales- 
cent home " was abolished in September, 1915, and auxiliary 
hospitals were then definitely classified as Class A and Class B 
hospitals. 

At first only the auxiliary hospitals which were not estab- 
shed as convalescent homes obtained a capitation grant. 
A flat rate of two shillings was sanctioned for each patient in 
them daily from the commencement of the war. This capita- 
tion grant was extended to the convalescent home class in 
March, 1915, but in the following month no further offers of 
private convalescent homes were accepted. The capitation 
grant was increased from time to time and additional grants 
were also sanctioned, so that the State aid to auxiliary hospitals 
was of a substantial character by the end of the war. As 
early as November, 1914, the flat rate was increased to three 
shillings per occupied bed daily, if such increase was considered 
necessary. In December, 1916, a grant of sixpence was sanc- 
tioned for each unoccupied bed, and in December, 1917, the 

* One medical officer, in an isolated country town in Wales, wrote in May, 
1915, to the director-general emphasizing this point. " We do not wish," 
he wrote, " to close down, as these small hospitals do a good work in keeping 
alive the people's interest in the war and we feel that if for no other reason 
than this, it would be unwise to remove the only object-lesson which an isolated 
country district like this can possibly have of the existence of our national 
struggle." 

f In March, 1917, an Army Council Instruction required a minimum of 
20 beds in new auxiliary hospitals established for officers, and a minimum 
of 40 beds in those established for other ranks. 



86 MEDICAL HISTORY OF THE WAR 

maximum rate for occupied beds was increased to three 
shillings and threepence for Class A auxiliary hospitals and 
to two shillings and sixpence for Class B.* In June, 1918, a 
further increase up to three shillings and ninepence per occupied 
bed was granted to certain Class A hospitals, which were 
performing the functions of a military hospital and receiving 
patients direct from overseas. 

Further grants from public funds were made to enable the 
voluntary aid organizations to remunerate doctors who were 
in medical charge of sick and wounded in auxiliary hospitals. 
In February, 1918, payment of fourpence daily for each equipped 
bed was granted for this purpose to those receiving patients 
direct from overseas, and threepence daily to others ; with a 
limit of payment of seventeen shillings and sixpence daily to any 
one civil practitioner in the case of the former, and twelve 
shillings and sixpence daily in the case of the latter ; but this 
grant was disallowed in the case of auxiliary hospitals receiving 
the maximum capitation grant, or a special grant of seven 
shillings daily for officer patients. Other financial arrangements 
were made to assist those auxiliary hospitals which undertook 
care and treatment of convalescents in billets as out-patients. 
Although several of the donors of auxiliary hospitals did not 
accept these capitation grants, and this was specially so in the 
earlier stages of the war, much financial assistance was given 
in this manner to the hospitals of voluntary organizations from 
public funds.j In addition, certain equipment was given by 
the military authorities on loan to the auxiliary hospitals. The 
hospital clothing, for example, was so supplied and also War 
Department marquees for purposes of expanding accommoda- 
tion ; but the employment of officers and men of the R.A.M.C. 
in them was permitted in very exceptional cases only. 

There was at the beginning and for some time afterwards a 
considerable amount of difficulty and confusion in the adminis- 
tration of auxiliary hospitals and control over the patients in 
them. A capitation grant on the basis of occupied beds tended 
to induce those in charge of an auxiliary hospital to retain 
patients in it who were otherwise fit for discharge or who 
ought to have been returned to larger hospitals for more 

* When convalescent homes became Class B auxiliary hospitals they did 
not participate in the increase of the flat rate from two to three shillings. 

f The published accounts of the cost of auxiliary hospitals show a total 
expenditure during the four years 1915 to 1918 of 10,556,598 13s. 5d., of 
which a sum of 7,760,727 Os. 3d. was borne by the War Office. This repre- 
sents expenditure on 813 auxiliary hospitals in 1915, 982 in 1916, 1,081 in 
1917, and 1,020 in 1918. In other words 70 per cent, of the cost was borne 
by the public. The balance was made up by voluntary subscriptions. The 
value, however, of the gratuitous personnel services of commandants and staff 
of auxiliary hospitals, large and small, cannot be estimated financially. 



HOSPITAL ACCOMMODATION 87 

suitable treatment, and consulting surgeons were at times 
emphatic regarding the unsatisfactory surgical results brought 
about by retaining patients in auxiliary hospitals unsuited for 
their treatment. Attention had also to be drawn to lack of 
discipline in auxiliary hospitals. These difficulties were met 
at first by the appointment of an inspector of hospitals,* 
whose duty it was to bring to notice the names of patients who 
were fit to be discharged ; and, later on in the year, auxiliary 
hospitals were called upon to submit weekly to the military 
hospitals to which they were affiliated a return showing the 
names of all patients who had been thirty days or longer in 
their charge. " Orders for patients in Auxiliary Hospitals " 
were issued by the War Office in May, 1915, but it was not until 
January, 1917,f that the respective responsibilities of county 
directors of voluntary aid organizations and the command 
military authorities in regard to auxiliary hospitals were clearly 
defined. County directors were then made responsible for the 
internal economy of auxiliary hospitals and were recognized as 
honorary officials of the military command in which their county 
was situated. They were to keep in close touch with the military 
administrative medical services in the command, the latter 
being responsible for seeing that the patients were adequately 
fed and treated and not retained for an undue length of time. 

In so numerous and extensive a variety of auxiliary hospitals 
wide differences in efficiency and suitability were bound to 
occur, but the military authorities of all commands pay tribute 
to the loyal and valuable assistance given to them by the county 
directors of voluntary aid organizations, without whose co- 
operation effective military administration of the auxiliary 
hospitals would have been a task of infinite difficulty if not 
practically impossible. 

The expansion of hospital accommodation in the United 
Kingdom was greatly increased by the accommodation provided 
for convalescents ; and the history of this is intimately asso- 
ciated with the work undertaken in the earlier months of the war 
by the Class B auxiliary hospitals. Homes for convalescent 
soldiers were offered in large numbers throughout the country ; 
and as early as the 31st July, 1914, the secretary of the Soldiers' 
and Sailors' Help Society,! who had done similar work during 
the South African Wai, informed the War Office that he was 
prepared to deal with all offers of convalescent homes, which 
might be placed at the disposal of the military authorities 

* Surgeon-General Price, A.M.S.(R.P.), appointed the 28th April, 1915. 
t A.C.I. 53 of January, 1917 modified, in some minor details by A.C.I. 614 
of the 31st May, 1918. 
J Major Tudor Craig. 



88 MEDICAL HISTORY OF THE WAR 

by private individuals. He was, however, informed at the time 
that the terms of the Field Service Regulations required all 
such offers, as already mentioned, to be submitted through the 
British Red Cross Society. He had in the meantime com- 
menced registering and classifying the offers which were 
reaching the Soldiers' and Sailors' Help Society. By the end of 
August, 1914, he had offers of accommodation for 8,273 con- 
valescents in homes where the donors were prepared to pay all 
expenses of maintenance ; for 4,299 in homes where donors 
asked for a contribution towards the expenses of feeding patients; 
and for 6,150 in unoccupied houses on which expenditure was 
necessary before they could be used. On these facts being repre- 
sented, the offer of the Soldiers' and Sailors' Help Society to find 
suitable homes for convalescent soldiers on sick furlough 
was accepted by the War Office on the 28th August, 1914. 
Major Tudor Craig's organization then became known officially 
as the Central Convalescent Home Registry. The object of 
the Central Registry was to place convalescents in homes 
near their own friends when discharged to sick furlough. Forms 
were prepared and distributed to all hospitals for use in sub- 
mitting an application for placing a convalescent ; and the 
Central Convalescent Home Registry on receipt of the applica- 
tion made arrangements for the reception of the convalescent 
into a home in the locality to which he wished to go. A vast 
amount of work was undertaken by Major Tudor Craig in 
organizing this system, and classifying the very numerous 
offers of homes. By the 9th September, 1914, he had on his 
register accommodation for 17,954, including 3,573 officers, 
in homes where the donors paid all expenses. The War Office 
drew up and issued rules for observance by the sick and wounded 
admitted to them, similar to rules which had been issued by 
the Admiralty for naval convalescents who were also being 
received into private houses. 

Although every assistance was given by the War Office and 
commands at home to enable convalescents to take full advan- 
tage of this organization, the system of central control had to 
be abandoned by the end of October, 1914, partly because there 
was a certain number of patients whom it was undesirable to 
send to private convalescent homes, partly because only 
a limited number were anxious to go on sick furlough to 
them and preferred to go to their own homes, but chiefly 
because of the difficulty in controlling the movements of men 
on sick furlough and getting them back to their units. In order, 
therefore, to utilize more fully the accommodation in convales- 
cent homes the central registry system was abandoned in 
November, 1914, and, instead, the deputy directors of medical 



HOSPITAL ACCOMMODATION 89 

services in each command were made responsible for keeping 
a register of the private convalescent homes available in the 
command, for transferring patients from hospitals under their 
control to them, and for the subsequent return of such patients to 
their units. Convalescent homes thus became merged eventually 
into the class of auxiliary hospitals, and in September, 1915, 
as already mentioned, the term convalescent home was 
abolished and the original convalescent homes designated 
" Auxiliary Hospitals, Class B." Convalescent officers, however, 
continued until the end of the war to be placed in convalescent 
homes through a central organization of officers' convalescent 
homes at the War Office, similar to Major Tudor Craig's 
Central Convalescent Home system. 

So long as accommodation was thus available for convales- 
cents, the Army Council's scheme* for establishing convales- 
cent depots on mobilization in barracks at Lichfield, Winchester, 
Shorncliffe, and Warley was in abeyance, although the question 
had been raised on the 24th August and again on the 10th 
September, 1914. In any case, all the barrack accommodation 
in the country was then required for recruits. 

The system of granting convalescents sick furlough to 
convalescent homes involved bringing them back to the military 
hospitals for final discharge after expiry of their sick furlough ; 
so that much of the advantage of using convalescent homes for 
keeping beds vacant in the military hospitals was lost. In 
many cases, too, officers commanding hospitals displayed some 
hesitancy in sending patients on sick furlough in consequence 
of the difficulty and responsibility involved in supervising them 
and getting them back again. It was also found impossible 
in auxiliary hospitals and private convalescent homes to 
carry out the measures necessary to make convalescents rapidly 
fit for duty overseas. These and other considerations, especially 
the urgent need of easing the pressure on the hospital accommo- 
dation in the United Kingdom, made it necessary early in 
1915 to establish organized military convalescent hospitals on 
a large scale. The earliest was opened at Eastbourne on the 
8th April, 1915, with accommodation for 3,840 convalescents. 
Four others were opened in the same year ; at Dartford for 
1,200 in May, at Epsom for 4,000 in June, at Alnwick for 
2,080 in August, and at Blackpool for 4,600 in October. With 
the exception of a small but useful convalescent hospital for 
460 beds in the barracks at Holywood, which was opened in 
January, 1916, no other military convalescent hospitals were 
opened until 1917, when three others were opened ; for 1,820 

* See Chapter I, p. 19. 



90 



MEDICAL HISTORY OF THE WAR 



convalescents at Ashton-in-Makerfield in April, for 872 at 
Woldingham in July, and for 4,560 at Plymouth in August. 

The following table shows the accommodation in and date 
of opening of these and other convalescent hospitals in the 
United Kingdom. 



Name of Hospital. 


Maximum 
number 
of beds. 


Date of 
opening. 


Military Convalescent Hospital, Eastbourne 


3,840 


8/4/15 


Orchard Military Convalescent Hospital, Dartford* . . 


1,200 


24/5/15 


Military Convalescent Hospital, Woodcote Park, 


4,000 


24/6/15 


Epsomf 






Military Convalescent Hospital, Alnwick.J 


2,080 


22/8/15 


Kings Lancashire Military Convalescent Hospital, 


4,600 


1/10/15 


Blackpool 






Military Convalescent Hospital, Holywood [| . . 


460 


15/1/16 


Military Convalescent Hospital, Ashton-in-Makerfield 


1,820 


14/4/17 


Military Convalescent Hospital, Woldingham. . 


872 


21/7/17 


Military Convalescent Hospital, Derriford Camp, 


4,560 


/a/if 


Plymouth 






Military Convalescent Hospital, Randalstown 


497 


1/10/18 



But in addition to those shown in this table convalescent 
hospitals were opened for Canadian and other Dominion 
troops in various places ; and a special convalescent hospital 
for men who had recovered from dysentery was opened at 
Barton-on-Sea in April, 1916. ^[ 

A large number of hospitals, chiefly auxiliary hospitals, was 
maintained for convalescent officers. Reference has already 
been made to the fact that the system of maintaining convales- 
cent homes for officers through a central registry was continued 
when the system was abolished for other ranks. Accommoda- 
tion for convalescent officers continued to be provided by 
numerous small auxiliary hospitals throughout the country, 
with the exception of 1,545 beds in the Military Convalescent 
Hospital at Blackpool, and 200 to 264 beds in Officers' Military 
Convalescent Hospitals at Moffat, Eaton Hall, Chester, 
Bournemouth, Harrogate, and Brighton. In August, 1918, 
the total number of beds for convalescent officers was 5,376 

* Handed over to the Australian military authorities, August, 1916. 

t Handed over to the Canadian military authorities, August, 1916, but 
continued to receive Imperial troops for some time afterwards. 

* Converted into a Command Depot, October, 1916. 
Includes 1,545 beds for officers. 

|l Transferred to Randalstown, October, 1916. 

TJ It was designated Dysentery Convalescent Depot, when it was opened, 
but the name was changed to Dysentery Convalescent Hospital in September, 
1916. It had previously been a depot for sick and wounded of the Indian 
Contingent, when fit for discharge from hospital, having been opened for this 
purpose in November, 1914. 



HOSPITAL ACCOMMODATION 91 

distributed amongst 82 different hospitals, the majority 
being hospitals with some 20 to 40 beds each. As many as 
thirty-one were in the Southern Command, fifteen were in the 
Western, fourteen in the Eastern, seven each in the London 
and Scottish Commands, and four each in the Northern 
Command and Ireland. 

Finally, hospital accommodation was greatly relieved by the 
formation of the units known as Command Depots. Strictly 
speaking these were not medical units, but they performed 
functions similar to those of the military convalescent hospitals. 
They were established originally towards the end of 1915 
owing to the large and increasing number of soldiers invalided 
from the expeditionary forces, who, for a considerable time, 
were unfit to be included in reinforcement drafts and required 
special arrangements for their administration and medical 
treatment. They were the class of men who would otherwise 
have drifted into auxiliary hospitals or would have been re- 
tained for lengthened periods in the reserve units and regimental 
depots, occupying accommodation required for home garrisons 
and drafts. Instructions were consequently issued in October, 
1915, for the formation in each command of depots to which 
men requiring special treatment on discharge from hospital, 
such as was not obtainable in the reserve or regimental depots, 
were to be sent if not likely to be fit for service overseas within 
three months. The medical treatment in these Command 
Depots was that of graduated exercises, including massage and 
therapeutic gymnastics, the ultimate object being to harden 
invalids sufficiently to enable them to join their reserve batta- 
lions within six months in a condition fit for drafting overseas. 
In April, 1918, twenty Command Depots* with a total accommo- 
dation for 75,500 had been established. This accommodation, 
however, is not included in the statement of hospital accommo- 
dation, although it was an important factor in providing accom- 
modation for men who might otherwise have filled convalescent 
hospitals, auxiliary hospitals, and small depot hospitals. 

There was one hospital, which was hot a military 
hospital, a convalescent hospital, or a command depot, but 
performed functions of all three at one time or another, and 
was therefore in a somewhat anomalous position, namely, 

* Enteric convalescents were not treated in convalescent hospitals, but 
in special enteric depots, which were regarded for administrative purposes 
as command depots. In this respect enteric convalescents were treated 
differently from dysentery convalescents, for whom a convalescent hospital 
was provided. The reason for this distinction being made is not clear. The 
object in each was the same ; namely, to keep dysentery and enteric convales- 
cents out of command or reserve depots until they were proved to be no longer 
carriers of disease germs. 



92 MEDICAL HISTORY OF THE WAR 

the Casualty Clearing Station established at Eastleigh, 
near Southampton. This was a medical unit, opened in 
April, 1915, with the object of receiving direct from hospital 
ships such cases as in civil hospitals would be out-patients and 
who consequently did not require special accommodation in 
ambulance trains for conveyance to other hospitals. Patients 
were there sifted out and sent to other hospitals by ordinary 
passenger trains or discharged as fit for duty after two or three 
weeks' stay in the unit. It was established at first in a school 
and small drill hall, and expanded into a larger drill hall, 
a railway institute, and several small Armstrong huts. The 
accommodation was thus increased from 220 beds in July, 1915, 
to 1,280 in March, 1917. When it was first established it was 
called a Clearing Hospital, but this name was changed to that 
of the Military Hospital, Eastleigh, in April, 1917, when it carried 
on the functions of continuous hospital treatment for slighter 
cases of wounds and sickness. This designation was again 
changed in January, 1918, to " Casualty Clearing Station, 
Eastleigh," and its previous function of receiving and treating 
slight cases from overseas, who would be fit for discharge in 
fourteen days, restored. After that period of treatment, 
patients, if still unfit, were to be transferred without delay 
to suitable hospitals.* 

In the general accommodation for sick and wounded in 
hospitals in the United Kingdom accommodation for special 
classes of wounds or sickness became more and more a prominent 
feature as the war went on, and many of the new hospitals as 
well as sections in the territorial force general hospitals and 
larger military hospitals were allotted for special cases only. 
At the beginning of the war special provision had to be made 
for acute mental cases. Later on special hospitals for the treat- 
ment of neurological patients were opened, and special beds 
assigned in each command for epileptics. Other conditions for 
which special hospitals or special beds were assigned were 
venereal diseases, cardiac conditions, rheumatic affections, 
malaria,dysentery,enteric group of diseases and affections caused 
by poison gas. Special orthopaedic hospitals, subsequently 
designated special military surgical hospitals, hospitals or 
sections of hospitals for treatment of fractures of the femur, 
for wounds of the jaw and face, for wounds of the head, for eye 
injuries, and for the limbless were also established. These 
occupied a considerable proportion of the total accommodation 



* A similar unit was opened at Canterbury when Dover became a large 
disembarkation centre, but, owing to the unsuitability of the camp, it was 
closed after being in existence for a short time only. 



HOSPITAL ACCOMMODATION 93 

available, more especially those set apart for the neurological, 
orthopaedic, and venereal class of patient. 

The Canadian, Australian, New Zealand, and South African 
Medical Services established hospitals, convalescent hospitals 
and special hospitals in the United Kingdom, and hospitals 
were also established for Indians at Brighton, Bournemouth 
and Brockenhurst when the Indian troops were in France. 
Many of these hospitals were taken over from hospitals already 
established for the Expeditionary Force. When the United 
States of America entered the war, their medical services 
also took over British hospitals, and at the time of the Armistice 
in November, 1918, had established or were establishing large 
new hospitals in the neighbourhood of Liverpool, Winchester, 
Netley, Portsmouth, and Devonport. 

In addition to the methods detailed above for expanding 
hospital accommodation in the United Kingdom after war 
was declared certain other expedients were adopted for use 
in emergencies. Thus in November, 1915, the floor space in 
in hutted hospitals was reduced from 80 to 60 superficial feet 
per bed and the number of beds permitted in a single ward 
increased to 50. Further, arrangements were made by which 
patients who could look after themselves were put into billets 
and treated as out-patients. Hospitals, in other words, were 
permitted to have billeting sections. This arrangement did 
not prove very satisfactory and was abandoned whenever it 
became possible to do so. 

It is somewhat difficult to obtain an accurate analysis of 
the proportion of beds obtained in each of the various classes 
of hospital established during the war, as there were con- 
stant fluctuations in the accommodation. But it is possible 
to analyse approximately some 317,000 beds which was a more 
or less constant hospital accommodation between the autumn 
of 1917 and the beginning of 1918.* The result of this analysis 
is shown in the following table. The special Red Cross Hospitals 
shown in the table refer to the two hospitals established at 
Netley, a special hospital for neurological cases in Liverpool, 
and two large hospitals at Glasgow established by the Scottish 
Branch of the Red Cross Society. 



* In 1918 a considerable and steady increase in hospital accommodation 
up to the time of the Armistice set in, and previous to August, 1917, a similar 
gradual increase had been going on since the beginning of the war. See Chart. 



94 



MEDICAL HISTORY OF THE WAR 



Table showing analysis of the Hospital Accommodation in 
August, 1917. 



Class of Hospital. 


Number 
of beds. 


Percentage 
of beds to 
total beds. 


Permanent Military Hospitals 


26982 


8-6 


T.F. General Hospitals 


48.234 


15-2 


New Military Hospitals 


47,455 


15-0 


War Hospitals (Asylums and Poor Law Institutions, etc.) 
Civil Hospitals 


53,536 
18 134 


16-9 
5-7 


Convalescent Hospitals 
Canadian Hospitals 
Australian Hospitals 
New Zealand Hospitals 


14,198 
11,615 
3,941 
4,166 


4-5 
3-7 
1-2 
1-3 


South African Hospitals 
Prisoners of War Hospitals 


619 
3,397 


2 
1-0 


Auxiliary Hospitals 


81,505 


25-7 


Special Red Cross Hospitals 


3,293 


1-0 


Total beds 


317,075 


100-0 



An analysis of the total beds equipped in the different 
commands at the time of the Armistice is shown in the follow- 
ing table : 

Equipped Beds in the United Kingdom for week ending 
15th November, 1918. 



Command. 


Officers. 


Other ranks. 


Total. 


Aldershot 










153 


8,270 


8,423 


Eastern 










2,427 


82,228 


84,655 


Irish. . 










356 


7,445 


7,801 


London 










5,884 


30,780 


36,664 


Northern 










1,597 


53,615 


55,212 


Scottish 










1,112 


23,179 


24,291 


Southern 










3,861 


67,218 


71,079 


Western 










3,612 


72.018 


75,630 


Channel Islands 








36 


342 


378 




19,038 


345,095 


364,133 



HOSPITAL ACCOMMODATION 



95 



Owing to the constant fluctuations in the beds allotted for 
special diseases or wounds no adequate analysis has been 
made ; but on the 31st March, 1919, the following equipped 
beds were in existence for certain special cases : 

Special Beds equipped 31st March, 1919. 



Class. 


Total beds 
equipped, in- 
cluding beds 
for Officers. 


Officers 
only. 


Malaria 


2660 




Mental .. .. . . .. . . .. 


4 200 


70 


Neurological 
Dysentery 
Prisoners of War 
Venereal . . .. .. .. .. . . 


9,350 

4,680 
8,500 
8620 


270 
70 
240 
580 


Orthopaedic 


18,540 


890 




56,550 


2,120 



On the same date a classification which is shown in the 
following table was made of the number of beds in certain 
classes of building : 



Nature of building. 



Total beds 
equipped, includ- 
ing beds for 
Officers. 



Civil Hospitals . . 


16000 


Schools 


26,853 


Board of Control Premises 
Huts 


20,906 
43 830 


Poor Law Premises 


55 573 








163,162 



Auxiliary hospitals may be considered as excluded from the 
analysis shown in these two tables. 

The chart shows graphically the increase in hospital accom- 
modation in the United Kingdom from time to time and the 
number of beds occupied and 'vacant. 



CHAPTER VI 

THE RECEPTION, DISTRIBUTION AND DISPOSAL OF SICK AND 
WOUNDED IN THE UNITED KINGDOM 

A SCHEME for the reception and distribution of sick and 
Jl\ wounded was prepared immediately war was declared, 
and after it had been fully considered on the 12th August, 
1914, at a War Office conference of all branches concerned, 
including the finance branch, it was issued to commands 
at home and to voluntary aid organizations on the 25th 
August in the form of " Preliminary instructions for the 
reception and distribution of sick and wounded from over- 
seas." The scheme was based on an arrangement made on the 
outbreak of war by which all sick and wounded from overseas 
would disembark at Southampton and be distributed from 
there. Its general principle consisted in the larger military 
and territorial force general hospitals receiving the sick and 
wounded direct from the port of disembarkation, and for 
vacant beds being maintained for fresh arrivals by transferring 
patients to the civil hospitals, to the smaller military hos- 
pitals, and to the private or auxiliary hospitals according to the 
nature of treatment which each of these hospitals was in a 
position to carry out ; as well as by discharging on sick furlough 
to their own homes or to private convalescent homes patients 
who were no longer in need of hospital treatment, and invalid- 
ing from military service those who were permanently unfit. 
In order to give effect to this principle the hospitals receiving 
patients direct from the port of disembarkation were called 
central hospitals, and those hospitals to which patients were 
transferred were affiliated to them for purposes of military 
discipline, maintenance of records, general supervision, and 
disposal of the sick and wounded. Each central hospital 
thus formed the centre of a group of affiliated auxiliary 
hospitals. 

These preliminary arrangements were subject to modifica- 
tion as time went on* ; and as additional large military 

* In communicating the instructions to commands, the Army Council 
clearly indicated that they were not to be regarded as hard and fast rules, 
but only as principles upon which the distribution of sick and wounded should 
be carried out. 

96 



DISPOSAL OF SICK AND WOUNDED 97 

hospitals were established, these, too, became central hospitals 
with a certain number of affiliated hospitals allotted to each. 
In some commands the general principle was modified to meet 
the ever-increasing number of hospitals and the expansion of 
their accommodation ; so that in them the affiliated hospitals 
were eventually either civil hospitals allotting a certain number 
of beds to military patients, or auxiliary hospitals of Class A 
or B provided by voluntary aid organizations, while other hos- 
pitals, such as the new military hospitals and war hospitals, 
became themselves central hospitals of a group of auxiliary 
hospitals. 

The number of hospitals affiliated to a central hospital was 
regulated so far as possible in order to secure a more or less 
uniform proportion of beds to the beds in the central 
hospital. The modifications, however, which were made in 
this respect in the different commands did not follow on 
similar lines. While the Aldershot, London, Eastern and 
Southern Commands followed the general principle, the Irish 
and Scottish Commands included amongst their affiliated 
hospitals a considerable number of units which in other 
commands would have been classed as central hospitals. The 
Western Command showed the greatest divergence from the 
general principle. In this command not only auxiliary, civil, 
and poor law institution hospitals, several with accom- 
modation ranging from 400 to 800 beds, but large new military 
hospitals, such as the Frees Heath Camp Hospital with 600 beds, 
the Kimnel Park Military Hospital with 890 beds, the Oswestry 
Camp Hospital with 866 beds, and special hospitals, such as 
the Alder Hey Hospital with 830 beds and the Belmont Road 
Hospital, Liverpool, with 950, were regarded as affiliated to 
a central hospital instead of becoming themselves the central 
hospital of a group. No definite policy appears to have 
existed for classifying new hospitals as central hospitals, 
according to their size, nature, or importance, or for 
determining the proportion of beds in a central hospital 
to those in its affiliated group. Consequently there is the 
spectacle in the Western Command of the 1st Western 
Territorial Force .General Hospital, with accommodation 
in 1917 for 3,000, having hospitals affiliated to it with 
a total accommodation for 10,000 ; while the 2nd Western 
General Hospital, with accommodation for some 5,000, had 
accommodation for over 17,000 affiliated to it. No doubt 
much of this diversity in the application of the general principle 
was due to the modification of the preliminary instructions 
being left to the discretion of the individual commands. 

In February, 1916, the attention of commands was drawn 

(1735) H 



98 MEDICAL HISTORY OF THE WAR 

by an Army Council Instruction to the distribution of military 
patients between military and auxiliary hospitals, pointing out 
that, while it would be uneconomical to leave military hospitals, 
the maintenance of which was a direct charge against public 
funds, empty or nearly so in order to fill auxiliary hospitals to 
which capitation grants for occupied beds were given, civil and 
private auxiliary hospitals could not be expected to continue 
indefinitely to reserve beds and maintain establishments if they 
received no patients in respect of whom grants were payable. 
It was left to the discretion of commands, therefore, to allot a 
fair proportion of patients to the auxiliary hospitals, the larger 
share going to those receiving a lesser capitation grant, in order 
to relieve the public as much as possible of the cost of the higher 
capitation grants. Whatever may be said in favour of the 
methods adopted in the Western Command, the need of definite 
instructions regarding the proportion of affiliated beds to cen- 
tral hospital beds was much felt, if for no other reason than the 
desirability of maintaining an equable number of occupied beds 
in the hospitals whose finances depended on capitation grants. 
Central hospitals with a proportion of three affiliated beds to 
one central hospital bed were much less likely to be in a posi- 
tion to keep the auxiliary beds filled with suitable cases than 
central hospitals with a smaller proportion of affiliated beds. 

Instructions of the 12th October, 1914, and of the 1 1th Novem- 
ber, 1915, gave the D.D.M.S. of a command authority to select 
suitable private and civil hospitals for the reception of patients 
direct from the port of disembarkation. This was construed 
as an authority for certain of the Class A auxiliary hospitals 
to receive patients direct, although they continued to be affili- 
ated to a central hospital. Some of them were well equipped, 
staffed, and situated, but this was not invariably the case, and 
local influences were often brought to bear on a D.D.M.S. to 
grant the authority to unsuitable hospitals. To become a 
primary auxiliary hospital, as such hospitals were designated, 
was a coveted distinction. The arrangement, however, by 
which certain auxiliary hospitals received sick and wounded 
direct facilitated distribution from the ports of disembarka- 
tion, as double transfers by rail were avoided, especially when 
the auxiliary hospitals concerned were at some distance from 
a central hospital. 

The scheme for the reception and distribution of patients 
was based then upon this grouping of affiliated hospitals with 
central hospitals, and a special administrative appointment 
was created to control the arrangements. Surgeon-General 
W. Donovan, who had retired from the Army Medical Service 
a few years previously, undertook the duties of the appoint- 



DISPOSAL OF SICK AND WOUNDED 99 

ment. He was graded at the beginning of the war as a deputy 
director of medical services for embarkation duties.* In 
April, 1917, his grade was raised to that of a director of medical 
services. He directed the reception and distribution of sick 
and wounded from Southampton until his office was trans- 
ferred to London in September, 1917. 

There was already an embarkation medical officer on the 
permanent peace establishment of the Southampton embarka- 
tion staff, with a small detachment of the R.A.M.C. and 
a medical store in charge of a quartermaster of the R.A.M.C 
They formed the nucleus of the larger administrative organiza- 
tion which was improvized after war was declared. 
Major Anderson, the embarkation medical officer,f and 
Major Wilson, the quartermaster in charge of stores, continued 
to carry on their duties under Surgeon-General Donovan, and 
Major Henderson was added to the establishment as 
staff officer. J 

This embarkation directorate subsequently assumed wide 
administrative responsibilities. New ports of disembarkation 
were opened as reception and distributing centres for sick and 
wounded, and the control and supervision of the personnel and 
equipment of ambulance trains in the United Kingdom and of 
hospital ships based on cross channel and Mediterranean ports 
were added to its duties. 

Dover was opened as a disembarkation port in January, 1915, 
and a distributing centre formed at the new station of the 
South Eastern and Chatham Railway there. A portion of the 
Southampton disembarkation staff was sent to it under Major 
Ellery, R.A.M.C., as D.A.D.M.S. Embarkation. It had a 
strength at first of 40, but, as the volume of the work at Dover 
increased, between 200 and 300 officers and other ranks of the 
R.A.M.C. were employed on reception and distribution duties 
there. The control of distribution, however, was centralized 
at all times in the office of the D.M.S. Embarkation. 

An attempt was made, in 1915, to establish a disembarka- 
tion centre at Portland with a view to relieving congestion 

* The term " for embarkation duties " was the official designation before 
the war for medical services connected with embarkation and disembarkation 
of troops ; and the term was not altered, although it did not indicate the main 
function of this medical staff during the war. 

f He was graded as an A. D.M.S. Embarkation in September, 1915. He 
was succeeded in June, 1916, by Lieut. -Colonel H. M. Nicholls. 

J He was succeeded in November, 1914, by Major Leslie, graded as a 
D.A.D.M.S. Embarkation in April, 1916. 

Both at Southampton and Dover, during periods when large numbers 
of sick and wounded were arriving, much assistance was obtained by local 
voluntary aid detachments, who acted as stretcher bearers, and also in 1916 
at Southampton by naval detachments from H.M.S. " Hermione." 

(1735) H 2 



100 MEDICAL HISTORY OF THE WAR 

at Southampton, more especially for ships carrying Indian sick 
and wounded. The port proved unsuitable, and was soon aban- 
doned. No R.A.M.C. personnel was allotted as an embarka- 
tion staff, but an arrangement was made for 20 to 30 men of 
a local voluntary aid detachment to attend each disembarkation 
on a grant to each of four shillings daily for his out-of- 
pocket expenses. This proved an economical and efficient 
arrangement. 

The next port intended for disembarkation of sick and 
wounded was Avonmouth. It was opened for reception of 
patients arriving in hospital ships from the Mediterranean and 
other distant ports. An embarking medical officer, subse- 
quently graded in March, 1918, as a D.A.D.M.S. Embarkation, 
with one N.C.O. and two men were appointed as embarkation 
medical staff, a local voluntary aid detachment providing the 
necessary stretcher bearers on similar terms to those in force 
at Portland. 

Hospital ships arrived from time to time at Devonport, 
and similar arrangements were made for establishing a 
reception and distributing centre there, Lieut. -Colonel 
Gibbons, I M.S., with a small R.A.M.C. personnel, being 
appointed D.A.D.M.S. Embarkation, and graded as such in 
October, 1917. 

Liverpool, London, and Glasgow were occasionally used as 
ports of disembarkation, and also had a D.A.D.M.S. Embarka- 
tion appointed for purposes of administration at each. Other 
ports used were Tilbury, Boston, Hull, Leith, Folkestone, and 
Newcastle.! 

Liverpool and Tilbury were used for disembarkation of in- 
valids from the Far East, and Leith for hospital ships 
from North Russia. Boston and Hull were used for 
reception of sick and wounded repatriated prisoners of war. 
At none of these ports was it necessary to maintain a 
R.A.M.C. staff for disembarkation duties. The local volun- 
tary aid detachments or personnel detailed from local 
hospitals provided stretcher bearers, when these were re- 
quired ; but an embarking medical officer and clerical staff 
were appointed, under the direct control of the D.M.S. 
Embarkation, to each port to which no D.A.D.M.S. Em- 
barkation had been allotted. 

The total number of sick and wounded disembarked and 
distributed from all these ports between the 28th August, 1914, 
and the 31st July, 1919, was 129,675 officers and 2,525,350 

t The two last named were not recognized as regular ports of disembarka- 
tion of sick and wounded. 



MEDICAL EMBARKATION STAFF 

AS CONSTITUTED FOR HOME SERVICE. 



D.A.D.M.S. 

I.Q.. M. 

23 OTHER RANKS 




A.O.M.S. 

a A. o. M.S. 

5 ATTACHED M Os. 
Z Q MS. 



O.A.D.M.S. 

4 ATTACH ED 
OFFICERS 

222 OTHER RANKS 

COMPANY RXM.C. 



D.A.O.M.S. 

2 OTHER RANKS 



[AMBULANCE TRAINS] [HOSPITAL SHIPS] [HULL, BOSTON, TILBURY. LEITH. 



24 OFFICERS 
Z64 OTHER RANKS 



OFFICERS 
NURSING SISTERS, 

OTHER RANKS. 
(AS REQUIRED] 



I EMBARKATION MEDICAL OFFICER 
AT EACH. 



M&JbyiSor\s.Lith. 



DISPOSAL OF SICK AND WOUNDED 101 

other ranks* ; the number received at each port being as 
follows : 

Southampton 59,710 Officers. 1,257,928 other Ranks* 

Dover 67,008 1,226,337 

Avonmouth 1,628 21,258 

Devonport 636 7,572 

Liverpool 34 1,594 

Folkestone 1,840 

Newcastle 15 93 

Boston 349 3,726 

Leith 252 4,196 

London Docks 19 121 

Hull 24 685 

It will be seen that the bulk of the work of reception and 
distribution took place at Southampton and Dover. 

The R.A.M.C. personnel employed by the medical embarka- 
tion staff had their headquarters in Southampton Docks and 
were formed into a separate company of the R.A.M.C. No. 48 
in August, 1918.J The detachment at Dover was orginally 
obtained from No. 11 Company at Canterbury, but it became 
merged into No. 48 Company when the latter was formed. 
The strength of the Company varied from 300 upwards, and 
in addition to performing clerical and bearer duties at the 
reception and distributing centres, supplied detachments for 
the ambulance trains and replaced casualties in hospital ships. 
The directorate was demobilized in July, 1919, but its 
D.A.D.M.S. was then retained at the War Office on the 
Director-General's staff as a section of the branch dealing with 
hospital accommodation and statistics. He continued in this 
capacity to administer the reception and distribution of sick 
and wounded, ambulance trains and hospitals. 

The successful working of the improvized medical adminis- 
tration for the reception and distribution of sick and wounded 
was only possible by the co-operation and support of the 
Directorate of Movements at the War Office, the Transport 

* In addition to these numbers 243 Belgian officers and 9,100 Belgian 
soldiers ; 1,517 officers and 44,682 other ranks, enemy prisoners of war ; and 881 
officers and 19,791 other ranks, British repatriated prisoners of war, were 
received. 

Many more Belgian sick and wounded were received and distributed in 
England at the beginning of the war, but came in ships not under the control 
of the Directorate of Medical Services, Embarkation. 

f The R.A.M.C. Company at Southampton Docks was known as Port 
No. 1 Company, R.A.M.C., some time before it was formed into No. 48 
Company. 

Major Shires, who succeeded Major Leslie in June, 1918. 



102 MEDICAL HISTORY OF THE WAR 

Department of the Admiralty and their representatives at the 
different ports with whom the director of medical services 
embarkation and his staff were in constant touch. 

Sick and wounded on disembarkation at a reception and dis- 
tribution centre were formed into convoys and entrained for 
conveyance by rail to the various central or primary auxiliary 
hospitals throughout the country. In order to organize suit- 
able convoys each hospital authorized to receive patients 
direct from the port of disembarkation was required to 
inform the D.M.S. Embarkation by telegram twice weekly, 
and subsequently daily, of the number of vacant beds 
available in it. 

There were many difficulties and complications during the 
course of the war in arranging the convoys. At first efforts 
were made to send patients to hospitals in the neighbourhood of 
their own homes, but this only met with partial success. It was 
seldom possible to arrange a complete train-load of wounded 
whose homes were in the same locality ; or it might happen 
that the number of beds vacant in the hospitals there was 
insufficient. Apathy on the part of the patients themselves was 
also responsible for difficulties in suitable distribution, for, in 
spite of every encouragement, many men seemed unwilling to 
apply for any special destination or delayed doing so until it 
was impossible to comply with their request. 

Then came the complications which arose when the system of 
allocating cases for special hospitals at home was introduced 
under the influence of specialist administration. The number 
of special classes of cases which arrived on ships labelled for 
special destinations or requiring special consideration in form- 
ing the convoys exceeded twenty at one time, not including 
those belonging to the Dominion Forces or special branches of 
the service. These special cases included officers suffering 
from neurasthenia and other special diseases ; medical and 
surgical neurological cases amongst other ranks ; injuries 
to the skull ; heart cases ; orthopaedic cases ; patients 
under Carrel-Dakin treatment ; jaw injuries and those 
requiring plastic operations ; nephritis and early nephritis 
cases ; chest wounds ; ophthalmic patients ; cases of total 
blindness ; enteric, dysentery, and mental patients ; carriers 
of infective diseases, labelled according to the disease ; wounds 
of arteries ; burns ; wounds of the bowel or rectum ; wounds 
involving fractures of the femur ; and cases for discharge as 
permanently unfit. In addition to these special cases, sick and 
wounded would arrive labelled for a Royal Air Force officers' 
hospital at Hampstead, or as prisoners of war, nursing sisters, 
members of St. John Ambulance Voluntary Aid Detachments, 



DISPOSAL OF SICK AND WOUNDED 103 

members of British Red Cross Society Voluntary Aid Detach- 
ments; Australian, Canadian, New Zealand, Newfoundland, 
South African and Indian Contingents ; Americans, Belgians, 
or other Allies ; all intended for special distribution. 

Until 1918 a separate label was attached to each class of 
case, and the multitude of labels became a source of confusion 
and error. This was remedied by attaching a gummed red 
label with a white centre to the envelope containing the field 
medical card, which each patient carried attached to his coat 
in some conspicuous position, the class of case for distribu- 
tion being marked on the white centre of the label. 

A patient not coming within any of the above categories was 
labelled with a number showing the section of the United 
Kingdom to which he selected to go. For this purpose the 
D.M.S. Embarkation divided the country into five hospital 
sections as follows : 

Section I. London and South Eastern, including the 
hospitals at Woolwich, Chatham, Southend, Brighton, 
Shorncliffe, Broadstairs, and Aldershot. 

Section II. South Western, with hospitals at Devon- 
port, Plymouth, Torquay, Exeter, Weymouth, Bourne- 
mouth, Netley, Portsmouth, Bristol, and Cardiff. 

Section III. Midlands, with hospitals at Birmingham, 
Nottingham, Bedford, Cambridge, Ipswich, Colchester, 
Bury St. Edmunds, Norwich, Leicester, Northampton, 
and Derby. 

Section IV. Northern, with hospitals at Leeds, Lincoln, 
Liverpool, Manchester, Newcastle, Sheffield, and York. 

Section V. Scotland. 

This geographical distribution was arbitrary and did not 
correspond with the geographical areas of commands in the 
United Kingdom. 

At one time the distribution of sick and wounded to Ireland 
was provided for specially outside the control of the D.M.S. 
Embarkation, patients belonging to Ireland being as a rule em- 
barked at the overseas ports in ships sailing to Dublin direct. 
In these cases the arrangements for their reception and distribu- 
tion came under the administration of the D. D.M.S., Irish Com- 
mand. Only in a very few instances was advantage taken of this 
arrangement. As a rule invalids for Ireland were disembarked 
at Southampton or Dover, conveyed by ambulance train to 
Holyhead, and embarked in a hospital ship there, under the 
control of the D.M.S. Embarkation. This method of trans- 
ferring patients to Ireland, however, did not work well and was 
abandoned. Arrangements were then made for concentrating 
Irish sick and wounded in hospitals in the South of England, 



104 MEDICAL HISTORY OF THE WAR 

and, when a sufficient number had accumulated, they were em- 
barked in a hospital ship at Southampton or Liverpool and 
conveyed thence to Dublin. 

The task of distributing a convoy of sick and wounded from 
the reception centre, as may well be imagined from this list 
of requirements, was complicated and difficult ; but it was well 
managed by Surgeon-General Donovan and his staff. 

Mention has already been made of the twelve ambulance 
trains which were mobilized in August, 1914, for use on the 
home railways.* Prior to the declaration of war there was 
only one military ambulance train in the country. It was con- 
structed for distribution of sick and wounded arriving in England 
during the South AfricanWar and consisted of five coaches, each 
carrying 12 cot and 6 sitting cases, or 20 sitting cases. After 
the South African War it was garaged at Netley and used for 
conveyance of invalids, arriving from stations abroad, to Netley 
and Woolwich. The coaches proved very useful for supple- 
menting the new ambulance trains, and for attaching to ordinary 
passenger trains when only small numbers of sick and wounded 
had to be distributed. The construction of the twelve new 
trains was ordered on the 5th August, 1914. The Great Eastern, 
Lancashire and Yorkshire, London and North Western, London 
and South Western Railway Companies prepared one each ; 
and the Midland, Great Western, and Great Central two each.f 
Two trains were prepared by the Great Northern and Great 
Southern and Western Railways of Ireland for use in Ireland. 

It was originally estimated that it would take six weeks to 
prepare these ambulance trains, and when the orders were 
issued for their construction it was suggested that voluntary 
aid detachments should prepare improvized ambulance trains 
for immediate use pending the preparation of the permanent 
trains. The first of the ambulance trains, however, arrived at 
Southampton Docks on the 24th August, and the others by 
the end of the month, in ample time for the distribution of 
the first ship-loads of wounded from France. In the mean- 
time two trains were improvized locally by voluntary workers 
in the Scottish Command. They were made up of goods vans 
with swinging cots ; one being stationed at Aberdeen and the 
other, provided mainly at the expense of Mr. Whitaker, the 
chairman of the North British Railway, at Edinburgh. The 
former was scarcely ever used, and the latter was employed 
chiefly in connection with naval medical services. 

Each ambulance train was designed to consist of ten eight- 

* See footnote to p. 51, Chapter III. 

t The total cost of the trains was 23,984 3s. 9d. 



DISPOSAL OF SICK AND WOUNDED 105 

wheeled coaches, five of them being wards for 20 patients each, 
and the others a kitchen car, a pharmacy car with bath and 
operating room, and three cars for the staff and stores. Later 
this design was modified by replacing one of the cars 
for the staff by an additional ward coach, making a total capa- 
city for 120 cot cases. It was found possible to do so by limit- 
ing the number of stores carried. Eventually, eight more 
ambulance trains of similar construction were added for use 
on the home railways. The twenty ambulance trains, thus 
available, were still further supplemented by two or more 
emergency vans being attached as required to each. These 
emergency vans were vestibule bogie vans each equipped with 
ten stretchers on the floor and ten in tier over them on special 
trestles. The carrying capacity of a train could thus be 
increased, if necessary, from 120 to 200 lying down cases. 
A number of passenger corridor coaches was also always avail- 
able to attach to the ambulance trains for sitting cases. Thus 
an ambulance train might have attached to it, for example, one 
vestibule van and three corridor coaches giving a total capacity 
of 140 lying down and 150 sitting up. There was, however, no 
limit to the number of corridor coaches, provided the weight 
and length of the train met the requirements of the railway 
authorities. 

Two other permanent trains were formed by combining six 
of the vestibule vans, and attaching to them a kitchen car and 
three passenger coaches. They carried 120 lying down cases 
each, and, although not so comfortable as the ambulance trains, 
they proved useful and more economical than the ordinary 
passenger trains which had to be used previously in emergency 
for lying down cases. For sick and wounded able to walk 
and suitable for conveyance sitting up emergency trains con- 
sisting of passenger corridor coaches with a kitchen coach 
attached were also held in readiness at Southampton and Dover. 
They carried 300 to 500 patients each. 

The largest amount of accommodation available for distri- 
bution of sick and wounded by rail in the United Kingdom was 
reached in the early part of 1918. There were then 20 ambulance 
trains, 2 vestibule van trains, 6 war department coaches, and 
30 vestibule vans, with 2,400, 240, 72, and 600 cots respectively, 
or a total accommodation for 3,312 patients lying down, while 
for sitting up cases there were 10 emergency trains carrying 
a total of 3,000, and 48 coaches carrying 2,100. There was 
thus in one journey of the trains a total carrying capacity of 
8,412, which could and was increased in emergencies by some 
of the trains making more than one journey in a day.. By 
this means it was possible to distribute to hospitals from the 



106 MEDICAL HISTORY OF THE WAR 

ports of disembarkation the maximum number of sick and 
wounded arriving on any one day. This maximum was reached 
on the 6th July, 1916, when 10,112* patients were distributed 
from Southampton and Dover to various hospitals in the 
United Kingdom. During the week 3rd to 9th July of that 
year, 47,582 sick and wounded had arrived at these ports, 
and 121,160 during the month. This was the period of the 
severest strain on the work of reception and distribution during 
the war. 

During periods of great congestion of sick and wounded and 
because of the necessity of keeping a large margin of beds 
vacant in. hospitals overseas for future emergencies, many 
serious cases of recently wounded men arrived at the ports of 
disembarkation in the early days of the war. Such cases were 
all sent to Netley or London, but the gradual filling of available 
accommodation in the hospitals there made it imperative to 
provide accommodation for serious cases at more distant 
hospitals. In order that such cases and their fitness to travel 
should receive special consideration before being entrained, 
officers in charge of hospital ships were ordered to attach plain 
red labelsf to all patients whom they considered serious cases. 
The possibility of sending serious cases long distances by ambu- 
lance train gave rise to much criticism at first and caused anxiety 
to those responsible for determining their destination. Experi- 
ence proved, however, that long railway journeys in these trains 
did not have any prejudicial effect in the great majority of cases. 
In fact, the anticipation of going to a hospital near their own 
homes had a mental effect on patients which proved in many 
cases most beneficial. Secondary haemorrhage was the chief 
danger to be feared. A large proportion of the cases in which 
haemorrhage occurred were not to all outward appearance 
serious. Complete arrangements, however, existed on the 
ambulance trains for dealing with such accidents, and only two 
deaths are recorded on the ambulance trains amongst the first 
500,000 patients and six during the whole war out of over 
2,600,000 patients distributed. 

On the destination of a convoy being determined a prelimi- 
nary telegram was sent by the embarkation medical staff to the 
hospital concerned ; and on the departure of the train, the time 
of departure and particulars of the special cases and numbers 
entrained were communicated by telephone or telegram. On 
longer journeys further particulars were sent by telegram from 

* 7,902 from Southampton, and 2,210 from Dover. See also Appendix D, 
Tables I and II. 

f This was before the red label with the white centre was introduced. 
It was also nsed subsequent to the introduction of the latter. 



DISPOSAL OF SICK AND WOUNDED 107 

intermediate halting places. The responsibility for reception 
of the convoy on reaching its destination then rested with the 
officer in charge of the hospital, who was thus kept sufficiently 
warned as to the probable time of arrival and the nature of the 
cases for which provision had to be made. 

An economical feature in the running of the ambulance trains 
was introduced by sending convoys from Southampton or 
Dover to hospitals in the neighbourhood of other ports when 
the arrival of hospital ships at the latter was anticipated. By 
this means the running of empty trains to meet the ships was 
avoided and much saving in expenditure of fuel on " light- 
running " effected. This system of avoiding " light-running " 
was applied in a variety of other ways in the movement of 
ambulance trains. 

The personnel of an ambulance train consisted of an officer 
and eleven other ranks of the R.A.M.C., permanently on board. 
The personnel originally detailed were the nucleus staffs of the 
territorial force clearing hospitals, each of which consisted of 
one or more officers and five or six other ranks. As their units 
were gradually mobilized for service overseas they were replaced 
by staffs from their 2nd line units, or by R.A.M.C. personnel 
from the company at Southampton. Without exception they 
proved efficient and zealous, and the effective working of the 
ambulance trains at home was in a great measure due to their 
efforts and enthusiasm. Two nursing sisters were detailed for 
each journey. They were accommodated in a home near the 
railway stations at Southampton and Dover when their train 
was not running. Nursing sisters did not accompany the 
passenger trains carrying sitting cases. 

An important element in the distribution of sick and wounded 
was their detraining and transportation from the trains to the 
hospitals. Entraining at the ports of reception has already been 
noted as carried out by men of No. 48 Company, R.A.M.C., or 
by voluntary aid detachments and men detailed from local 
hospitals. The detraining and transportation at the end of 
the journey was almost invariably carried out by voluntary 
workers, both men and women, of all classes. The work 
accomplished by them, on many occasions at great personal 
inconvenience and sacrifice of valuable time, has been every- 
where referred to with expressions of praise and admiration. 
Convoys arrived at any hour of the day and night, and those 
who had registered themselves for duty at the railway station 
were invariably there on the arrival of the trains. Local 
automobile clubs rendered great assistance in many localities in 
organizing the transportation to the hospitals, as did also 
branches of the St. John Ambulance Brigade and St. John 



108 MEDICAL HISTORY OF THE WAR 

Ambulance Association, and voluntary aid detachments of the 
British Red Cross Society. In the " Preliminary Instructions " 
commands were instructed to consult the secretary of the 
Automobile Association and Motor Union with a view to organiz- 
ing the allotment of motor transport to hospitals ; and to keep 
registered voluntary aid detachments informed as far as possible 
of the movements of sick and wounded by ambulance train 
to enable them to form rest and refreshment stations at 
selected stopping places during the longer journeys. These 
refreshment stations as a rule were not necessary, however, 
for the ambulance trains carried all that was required for the 
journey, but they proved excellent and much appreciated 
institutions, particularly those established at Birmingham and 
Peterborough, for emergency trains and trains making long 
journeys. In some cases difficulties arose in the early months 
of the war in arranging accommodation for rest and refresh- 
ment places within the railway station premises. 

In order to relieve the Southampton distributing centre of 
congestion two special units were established in connection with 
it, the University War Hospital in the new university buildings 
there, and the Eastleigh Clearing Hospital, to which reference 
has already been made. The former was intended for the re- 
ception of serious cases considered unfit for longer journeys and 
it also served as a reception hospital for the retention of patients 
desirous of going to hospitals near their own homes until an 
ambulance train was being despatched to the locality concerned. 
The latter was for the temporary reception and detention of 
lighter cases pending their distribution to hospitals throughout 
the country or their discharge to duty. 

There was some difficulty at first in determining the number 
of beds which should be kept vacant for the sick of the troops 
in camps, billets and garrisons at home, and of the Central 
Force, for which the territorial force general hospitals were 
originally intended. Owing to the vacant beds in the terri- 
torial force general hospitals gradually being filled by sick and 
wounded from overseas, it became necessary, as early as the 
1st October, 1914, to issue an instruction that 300 beds should 
be kept in each of these hospitals for sick of the Central Force, 
and any of them unoccupied were not to be notified to the D.M.S. 
Embarkation as vacant in the telegram sent to him of beds 
available for convoys from overseas. 

In the early days of the war a large number of Belgian sick 
and wounded were disembarked in English ports. As many as 
57,000 were received during 1914 and 1915 into civil and other 
hospitals in the United Kingdom, amongst these were 243 
Belgian officers and 9,100 Belgian other ranks, who were sent 



DISPOSAL OF SICK AND WOUNDED 109 

to military hospitals in all commands by the embarkation 
medical staff from their distributing centres, and transferred 
to auxiliary hospitals and private convalescent homes, when 
sufficiently convalescent, in the same manner as British sick 
and wounded. But early in 1915 arrangements were made by 
the Belgian military authorities for opening Belgian hospitals 
for convalescent Belgian soldiers. These were known as King 
Albert's Hospitals, and were four in number three in London 
and one in Folkestone. They were ready to receive convalescent 
soldiers of the Belgian Army at the end of February, 1915 ; 
and, in April following, all those in private convalescent homes 
were transferred to them. 

Sick and wounded prisoners of war were also received and 
distributed in the earlier stages of the war to the British mili- 
tary hospitals in the same manner as British sick and wounded, 
and thus occupied beds in hospitals in all the commands. 
Special hospitals were subsequently established for them or 
wards allotted in certain selected military hospitals.* The sick 
from prisoners of war camps formed throughout the country 
in 1914 were also admitted in the earlier years of the war to 
the military hospitals in their neighbourhood. 

The responsibilities of the D.M.S. Embarkation were origin- 
ally confined to the supervision of the disembarkation and dis- 
tribution of the sick and wounded. He had no administrative 
responsibilities in connection with hospital ships which mobilized 
as units on the lines of communication of the expeditionary force. 
But when other and larger hospital ships were mobilized, as 
happened immediately, there were no clear instructions regarding 
the scale of ordnance stores, equipment and personnel for ships 
of varying size. They were fitted as such by the Admiralty 
authorities, the medical personnel and surgical and medical 
stores were detailed by the directorate of medical services at 
the War Office, but the medical officers appointed to the charge 
of hospital ships had to obtain their ward utensils, hospital 
clothing, and other equipment by requisition on ordnance stores. 
As many of these officers were inexperienced officers with 
temporary commissions, in the earlier days of the war some 
of the large hospital ships went to sea with insufficient equip- 
ment ; and there were also considerable anomalies in the scale 
of personnel detailed for duty on board. To obviate this the 

* The principal hospitals for prisoners of war were the Dartford War 
Hospital, the Prisoners of War Hospitals at Belmont, in Surrey, and 
Brocton, in Staffordshire, the military hospitals at Fargo and Sutton Veny in 
the Salisbury Plain area, at Oswestry in the Western Command, at Stobs in 
Scotland, and the Nell Lane Military Hospital, Manchester. Acute mental, 
enteric and dysentery cases were provided for in the special hospitals for 
such cases. 



110 MEDICAL HISTORY OF THE WAR 

responsibility of equipping all hospital ships, except in matters 
which were dealt with by the Admiralty, was added to the 
duties of the D.M.S. Embarkation. Scales were then drawn 
up for establishments of personnel, medical and surgical stores 
and ordnance equipment according to the size of a ship ; and 
standing orders and instructions for the officers in charge 
were issued.* 

The duties of the D.M.S. Embarkation were thus enormously 
increased. At one time approximately 100 hospital ships and 
ambulance transports, with a total personnel of 485 officers, 
836 nursing sisters, and 4,221 other ranks came under his 
administrative control. The personnel was calculated on a scale 
of one officer, two nursing sisters and 10 other ranks to every 100 
equipped beds. Some of the hospital ships were of very large 
size, such as the " Aquitania," " Britannic," and " Mauretania" ; 
the first, for example, being equipped to carry 4,000 sick and 
wounded.f Every requirement for medical and surgical treat- 
ment was provided, but it was found that, except in times of 
great emergency, these very large ships were not so generally 
useful as ships of moderate size. Only a limited number of 
harbours were capable of berthing them, and it was not always 
possible to secure a sufficient number of patients at a given 
time and place to fill them. The most efficient and economic 
unit was a hospital ship of 800 beds. Ships of this size could 
also carry a large number of lighter cases on deck in cross- 
channel work, and were well adapted for long distance voyages. 
The " Asturias " was a typical hospital ship of this class. It 
accommodated 800 patients in cots and berths, and in times 
of emergency as many as 2,400 were carried by it on one 
cross-channel journey. 

Increase in the number of hospital ships commenced in the 
earliest days of the war. The " Asturias " and " Carisbrooke 
Castle," which became military hospital ships in August and 
September, 1914, were originally chartered as naval hospital 
carriers by the Admiralty, and with the " Oxfordshire," 
which was acquired as a hospital ship shortly afterwards, and 
the three small cross-channel hospital ships mobilized with the 
expeditionary force, were the only ships employed in the earlier 
months of the war in the conveyance of sick and wounded 
from France to England. The first voyage with patients from 
France was made by the " St. Andrew." It arrived at South- 
ampton on the 28th August. 

* Standing orders and instructions were also issued for officers in charge 
of ambulance trains at home. 

t On one voyage the " Aquitania " carried 5,000 patients, and 20 ambulance 
trains were required for distributing them. 



DISPOSAL OF SICK AND WOUNDED 111 

The demand for more and larger ships continued and urgent 
requests for two more ships similar to the " Asturias " were 
made towards the end of November, in consequence of the 
large number of wounded and sick accumulating in the base 
hospitals in France after the first battle of Ypres and the onset 
of the cold weather with its toll of foot troubles and other 
complaints. The "Valdivia" and "Salta" were then taken 
up, and a cargo boat, the " Glenhead," was sent to Boulogne 
at the end of November for patients not requiring cots. 
Its only accommodation, however, was a hold and an 
exposed iron deck, and the military authorities in France 
considered it unsuitable for the purpose and sent it 
back empty. 

In the meantime the Indian contingent had arrived in France, 
and hospital ships, prepared for Indian sick and wounded, were 
made available for British. They had been admirably prepared, 
were large and comfortable, and were in every respect suitable 
for British as well as for Indian patients. It was first intended 
that Indian sick and wounded should be transferred by rail 
to Marseilles, and from there evacuated to Egypt and Bombay. 
The general policy was the subject, however, of much discussion 
between the Government of India, the War Office and the India 
Office, and resulted in the India Office eventually negotiating 
direct with the Admiralty for the preparation of its hospital 
ships.* The War Office was consequently informed by the 
India Office on the 2nd October that six ships, the " Sicilia," 
" Glengorm Castle," " Guildford Castle," " Goorkha," " Glenart 
Castle," and " Syria " had been engaged by it as hospital 
ships. 

Owing to the difficulties in arranging transport of Indian sick 
and wounded by rail to Marseilles the intention of using that 
port as the base for the hospital ships was abandoned, and in 
October arrangements were made for the reception of Indian 
patients into hospitals in the south of England. The " Glen- 
gorm Castle " and " Guildford Castle "f were then allotted for 
employment as channel service hospital ships and sailed for 
Boulogne on the 20th October. The other hospital ships for 
Indians were to be employed in taking Indian sick and 
wounded from England to Egypt, and from Egypt to Bombay ; 
but the arrangements which were being made between India, 

* Negotiations were commenced on receipt of a telegram from the Viceroy 
of India, on 4th September, estimating that some 1,300 sick and wounded 
would require to be sent back to India monthly ; and asking the War Office 
to have at least half of the eight ships, considered necessary, available soon 
after the arrival of the Indian contingent in France. 

t The " Guildford Castle " was damaged in collision with the " Carisbrooke 
Castle." and the " Goorkha " took its place. 



112 MEDICAL HISTORY OF THE WAR 

Egypt, the India Office, the War Office, the Admiralty and the 
military authorities in France appear to have been consider- 
ably confused and orders and counter-orders were of frequent 
occurrence, especially in connection with the sailings of the ships, 
and also in connection with their personnel. Indian personnel 
for the ships had not arrived from India when the ships were 
taken up and prepared in England and had to be obtained by 
depleting hospital units in France and placing some R.A.M.C. 
personnel on board. It was eventually decided in November 
that the Quartermaster-General at the War Office would take 
over their management from the India Office in order to avoid 
confusion and conflict of instructions. 

The reception and distribution of Indian sick and wounded 
in England thus came under the administrative control of the 
D.M.S Embarkation, and an Indian Medical Officer* was added 
to his staff. He had also to arrange for the embarkation of 
Indian invalids who were being transferred from England to 
Egypt and Bombay. At first the distribution of sick and 
wounded Indians was complicated by the lack of hospital 
accommodation for them in England. Temporary accommo- 
dation was prepared at Netley ; and the " Sicilia " was sent 
to Marseilles to convey an Indian General Hospital to England. 
The "Sicilia" arrived in Southampton on 31st October, 1914, 
- but was retained as a stationary hospital ship at Southampton 
to supplement the accommodation at Netley, until the general 
hospital, which was sent to Brockenhurst, was opened. The 
" Glengorm Castle " and the " Goorkha " were also kept full of 
patients as stationary hospital ships at Boulogne and also at 
Southampton until hospital accommodation on shore was ready. 
By December hospitals for Indians were established in the 
Pavilion at Brighton, and in Mont Dore Hotel, Bournemouth, 
with a convalescent depot at Barton-on-Sea. All these hospitals 
came under the administration of the War Office ; and the 
reception and distribution of Indian sick and wounded con- 
tinued to be carried on by the Embarkation Medical Staff at 
Southampton in the same manner as for British sick and 
wounded until the departure of the Indian Contingent from 
the Western Front in October, 1915f. 

In 1915 the extension of British operations to Egypt, the 
Dardanelles and Macedonia led to great additions to the fleet 
of hospital ships, for the administration of which the D.M.S. 

* Lieut.-Colonel MacNab. 

t Indian Cavalry Divisions and Indian Labour Companies remained 
with the Expeditionary Force in France till the end of the war, and the 
original scheme for evacuating them to Marseilles was adopted when the 
Indian hospitals in England were closed. 



DISPOSAL OF SICK AND WOUNDED 113 

Embarkation became responsible.* Hospital ships were sent 
to the Eastern Mediterranean in the spring of that year ; 
but, after the landing at Cape Helles and subsequently at 
SuvlaBay, a number of transports, including the " Aquitania," 
had to be prepared hastily for bringing wounded to England. 
The " Britannic " and " Mauretania " were also fitted out as 
hospital ships in 1915. The alterations necessary to convert 
them into hospital ships were carried out on their return to 
England. They were well equipped for surgical work, and 
urgent operative surgery was carried out to a great extent 
during voyages from the Dardanelles or Mudros to Egypt, and 
occasionally direct to England,more especially on the "Asturias," 
which was diverted from channel service for the purpose, and 
on the " Delta " and " Nevassa." These ships were based at 
Alexandria, but on their arrival at Southampton their medical 
services and requirements came under the.control of the adminis- 
trative medical staff for embarkation there. 

Torpedo attacks on hospital ships by enemy submarines or 
their destruction by mines have already been accepted as 
authenticated facts in the history of the war, although at no 
time were the conditions of the Geneva Convention as applied 
to naval warfare transgressed by the British.! It seemed as if 
the distinctive painting of hospital ships, white with a green 
band, marked them out for attack on account of their visibility. 
It was consequently determined that all distinctive marks on 
hospital ships, employed on the channel services at any rate, 
should be removed. They then no longer claimed the protection 
of the Geneva Convention and sailed as ordinary transports. 
Their equipment remained the same, but they were designated 
" ambulance transports " in place of hospital ships, were 
armed to repel attack, were entitled to a naval escort when 
necessary, and sailed under the Red Ensign. 

Sixteen hospital ships, including the naval hospital ship 
" Rewa," were lost.J 

The disposal of sick and wounded after their distribution 
to hospitals only came under the control of the D.M.S. 

* The administration of hospital ships was not definitely transferred from 
the lines of communication France and the Mediterranean to the D.M.S. 
Embarkation at Southampton until April, 1916. The hospital ships east of 
Suez were based on Bombay for administration and did not come under 
his control. 

f The Admiralty authorities were vigilantly on their guard against in- 
fringements of the Convention. It was suggested at one time, for example, 
that Indian patients transferred to Egypt could return to France, when fit 
for discharge, in an Indian hospital ship returning empty to England. The 
Admiralty, however, pointed out that soldiers returning to duty could not 
be conveyed in hospital ships, and any instructions to that effect were cancelled. 

J See Appendix C. 

(1735) I 



114 MEDICAL HISTORY OF THE WAR 

Embarkation when patients had to be transferred by ambu- 
lance train from one hospital to another, or from hospital to 
a port for repatriatibn to India or the Dominions. They were 
retained in hospitals so long as they were in need of hospital 
treatment. For discharge from hospital they were classified as 

(I) Fit for duty, 

(II) Fit for a command depot, 

(III) Fit for employment in home garrisons or labour 

companies. 

Men classified under I or III were discharged to their reserve 
units, where they were hardened or trained for drafting over- 
seas, or for duty at home. Those classified for command depots 
were men who though no longer in need of hospital treatment 
were unfit for the hardening and training in their reserve units, 
but who would be likely to be fit in six months. Only sick and 
wounded from an expeditionary force could be sent to a com- 
mand depot. But patients permanently unfit for any kind of 
military service were discharged from the army to civil life. 
Convalescents not fit for discharge were transferred to conva- 
lescent hospitals or auxiliary hospitals. They could be dis- 
charged from convalescent hospitals under the same classifi- 
cation as from central hospitals ; but patients in auxiliary 
hospitals and all patients permanently unfit for military service 
were returned to the central hospitals for disposal. 

The distribution and disposal of sick and wounded officers 
were specially legislated for. At the beginning of the war many 
irregularities occurred. Several officers arrived in England 
in private yachts and other vessels and disappeared for the 
time being from military control. The system of granting 
officers sick leave instead of retaining them under hospital 
treatment proved unsatisfactory and led to delayed or imper- 
fect recovery. In March, 1917, an instruction was conse- 
quently issued to the effect that all sick and wounded officers 
below the rank of colonel were to come under the same 
rules for reception, distribution and disposal as other ranks, 
and one large hospital, the Prince of Wales' Hospital,* was 
opened for them in the Great Central Hotel, Marylebone. 
Other hospital accommodation had been allotted for officers in 
central and special hospitals throughout the country, and the 
only distinction eventually made between the distribution of 
officers and the distribution of other ranks was the method of 
transferring them to auxiliary hospitals, convalescent hospitals, 
and command depots. In the c se of other ranks, central 

* It was at first called an Officers' Command Depot, but in August, 1917, 
the name was changed to Prince of Wales' Hospital for Officers. 



DISPOSAL OF SICK AND WOUNDED 115 

hospitals transferred patients on their own responsibility under 
the supervision of the A.D.M.S. of their district and D.D.M.S. 
of the command. In the case of officers, however, when 
a patient required transfer to a military convalescent hospital, 
to an officer's auxiliary convalescent hospital, or to a command 
depot, the transfer was effected only through the officers' trans- 
fer department, which was centralized in the office of the 
Director-General at the War Office.* A sick and wounded 
officer's transfer card was forwarded to the War Office by the 
officer in charge of the hospital, from which the officer was to 
be transferred, giving particulars of the case and recommending 
the locality to which transfer should be made. The transfer 
department at the War Office then allotted the convalescent 
hospital or command depot to which the case should go, and 
forwarded the transfer card to the latter. Transfer was then 
carried out in direct communication between the officers in 
charge of the hospital or command depot from and to which 
the case was being transferred. Every sick and wounded 
officer was examined by a medical board as soon as possible 
after his arrival from overseas ; and the board decided his fit- 
ness for general service, garrison or other service abroad, home 
service, active or sedentary, for admission to a command 
depot or for treatment in an officers' convalescent hospital or 
in an officers' hospital. In the event of an officer being 
classified for hospital treatment he could afterwards be 
transferred to convalescent treatment or a command depot 
only through the War Office transfer department. This 
centralized transfer arrangement did not work altogether satis- 
factorily, especially on account of the inconvenience and delay 
in the transfer of documents and in the arrangements for 
subsequent medical boards; but on the whole it tended to 
diminish the number of complaints and to remove a consider- 
able amount of confusion. 

The disposal of special cases of diseases or injuries amongst 
British and Dominion troops led to frequent instructions being 
issued and modified from time to time as new hospitals for 
them were opened, new methods adopted and new additions 
made to the class of cases regarded as special. As regards the 
disposal of enteric and dysentery convalescents, in no case 
could they be sent to convalescent hospitals or command depots. 
Enteric patients when bacteriologically free from infection after 
two examinations at an interval of seven days, and if then fit 
for discharge, were sent tr^the enteric depots at Shirley (near 
Croydon), Woldingham, and Warlingham, which were opened in 

* See p. 62, Chapter IV. 

(1735) I 2 



116 MEDICAL HISTORY OF THE WAR 

1916 and 1917. Until then they could be transferred to Class B 
auxiliary hospitals under observation for one month. Two 
examinations were made during that time, and if the results 
were negative the patient was discharged to his reserve unit, 
where three further examinations were made before he could be 
posted to a reinforcement draft. These rules were modified and 
relaxed before the end of the war, when only one further 
examination was made at the enteric depot, but the patient 
remained in it three months before being drafted to his reserve 
unit. Enteric depots were commanded by combatant officers 
and in all respects treated as command depots. They were 
established to avoid sending possible enteric carriers to other 
command depots. Dysentery patients were distributed on 
arrival to specially selected hospitals. They were there sub- 
mitted to treatment and to bacteriological and protozoological 
examination. When no longer in need of hospital treatment 
they were transferred to the dysentery convalescent hospital, 
Barton-on-Sea.* An additional examination was made there 
three weeks after termination of treatment or previous negative 
examination. The patient could then be discharged in the same 
manner as from other convalescent hospitals, if otherwise fit. 
The dysentery convalescent hospital was a hospital under the 
command of a medical officer, and not, as in the case of the 
enteric depots, a command depot. 

As regards the distribution and disposal of other special cases, 
blind patients were sent to the 2nd London General Hospital, 
Chelsea, heart cases to the Sobraon Military Hospital at Col- 
chester,f face and jaw cases to Queen Mary's Hospital, Sidcup, 
orthopaedic cases to a number of what were eventually in 1918 
designated special military surgical hospitals in the various 
commands, and neurological cases were similarly distributed to 
special neurological centres. Mental cases went in the first 
instance to Netley, which acted as a clearing hospital for such 
cases, and later on to one of the asylums opened as war hospitals 
where they came under the superintendence of the trained 
asylum staff taken over by the military medical services. 
Rheumatism and kindred complaints were provided for in 
Buxton, Harrogate, Bath, and Llandrindod Wells. The disposal 
of amputation cases was regulated by the readiness or otherwise 

* After this was closed in 1919, the Addington Park War Hospital 
became the dysentery convalescent hospital and also a central dysentery 
hospital. 

t The heart centre at Colchester was intended for special cases which 
could be cured by graduated physical training. Heart cases for special study 
and treatment went to the Mount Vernon Hospital, Hampstead, but this was 
closed after the Colchester Hospital had opened. Heart cases were also 
treated at other hospitals on the same principles as at Colchester. 



TABLE SHEWING DISTRIBUTION AND DISPOSAL OF SICK AND 
WOUNDED ARRIVING FROM AN EXPEDITIONARY FORCE. 




1 RESERVE UNITS & 
REGIMENTAL DEPOTS 




HOMESERVICE 
BATTALIONS & 
LA80URCOMFANIES 


^ 



EXPEDITIONARY FORCE 



REMARKS -.-This table does not include all details of the movement of sick & wounded in 



the United Kingdom but represents the general system of their distribution & disposal. 
Details left out are transfers to Srfrom special hospitals and direct admissions to primary 
auxiliary hospitals. The black squa res & tines indicate medical units where sick & wounded 
are under treatment The interrupted double square represents non-medical units, 
where men are hardened for fitness to be drafted to expeditionary forces. The double lines 
indicate the movement of men fit for drafts. The interrupted double lines indicate movements 
of men not yet fit for general service drafts, but fit for home service battalions or labour and 
employments with the expeditionary forces. The dot & dash lines & squares represent 
movements of men discharged as permanently unfit for military service. 



10314. 25739/4?6. ICOO.8.21 



MaJby&Sons.Lith. 



DISPOSAL OF SICK AND WOUNDED 117 

for fitting of artificial limbs, and hospitals were provided for 
the reception of limbless men waiting fitting. 

When it became necessary to send malarial convalescents from 
Salonika to England special instructions were issued for their 
disposal. Such patients were designated " Y Group, Malaria 
Cases." If they required hospital treatment on arrival they 
were sent to the University War Hospital, Southampton, and 
transferred from there to malaria centres in specially selected 
hospitals elsewhere. If admission to hospital was not considered 
necessary they were sent to their regimental depots with a 
malaria card and with instructions regarding their continuing 
quinine treatment for thirty days. The arrangement did not 
prove satisfactory, and a new policy was adopted in 1918 by 
which malaria concentration centres were opened in commands 
for all malarial cases not requiring hospital treatment, with 
a view to their being kept under specialist observation and 
drafted to a special depot for them in France. This arrange- 
ment had come into operation only shortly before the end of 
the war. 

Venereal patients were not generally transferred from expe- 
ditionary forces to England till after the Armistice, but special 
hospitals for venereal cases occurring amongst troops in the 
United Kingdom were opened in each command. The disposal 
and treatment of several other special classes of sickness and 
injuries were also the subject of instructions. 

The organization for the reception and distribution of sick 
and wounded and the general movement of sick and wounded 
on transfer from hospitals of the expeditionary forces to 
hospitals in the United Kingdom are illustrated in the 
diagrams. 



CHAPTER VII 

THE MEDICAL EXAMINATION OF RECRUITS 

THE various changes which took place in the system of 
recruiting for the army during the war had a profound 
influence on the medical services engaged in the work of 
medical examination of recruits. In the earlier months there 
was a short period of unrestricted voluntary enlistment, during 
which there was a wild rush of recruits who swamped the 
general arrangements for their reception and medical examina- 
tion. The existing organization, when war was declared, was 
a peace organization, capable of dealing with 50,000 recruits 
annually. Recruits were examined at regimental depots or 
recruiting centres by officers of the R.A.M.C. on the active or 
retired list, or, in some localities, by civil medical practitioners 
at a fee of 2s. Qd. for each recruit examined. Their work was 
supervised by medical inspectors of recruits, appointed to each 
command since 1905.* When the rush of applicants for en- 
listment occurred at the beginning of the war, not only was 
the number of experienced medical examiners insufficient, but 
the accommodation for examining recruits was totally inade- 
quate. In September, 1914, for example, as many as 500,000 
came up for enlistment. Large numbers of civil medical prac- 
titioners who had never previously examined recruits and who 
were ignorant of the physical requirements for the army had 
to be entrusted with the duties of medical examinations ; but 
although instructions had been issued on August 1st regard- 
ing the physical examination of recruits, followed by notes 
for, the guidance of examining medical officers, the most diverse 
results were obtained, and many men were admitted into the 
army unfit for general service. Although many were discharged 
before joining a draft for overseas, a certain number went to 
France where they became a serious encumbrance and were 
returned to the base immediately after joining their units in 
the field. Many of the disabilities from which they suffered 
were sufficiently pronounced to have been detected at the time 
of the medical examination ; and, while it was recognized that 
the results of the examinations by inexperienced civil examiners 

* Medical inspectors of recruits were withdrawn on the outbreak of war 
for duty with the expeditionary force, but were subsequently replaced. 

118 



EXAMINATION OF RECRUITS 119 

would necessarily fall below those obtained by officers of the 
regular medical service, the bad work brought to the notice 
of the Army Council could only in part be accounted for in 
this way and was in many cases due to the medical examiners 
attempting to inspect more recruits in a day than could be 
examined properly in the time. 

To remedy this state of affairs several measures were adopted. 
The flow of recruits was regulated and only those whom the 
military authorities could dispose of were medically examined 
and posted to units. Others could register their names as 
willing to serve when called upon. Registration was carried 
out by means of index cards, the names being submitted to 
a parliamentary recruiting committee or by personal application 
at a recruiting office. The cards were kept at the headquarters 
of the recruiting area and were for two classes, those willing 
to serve but wishing to defer enlistment to a later date, and 
those who could not be accepted at once owing to shortage 
of accommodation or other causes preventing their disposal 
by the military authorities. 

Shortly afterwards, in December, 1914, the Army Council 
also issued an instruction limiting the number of recruits whom 
one doctor should examine to six or eight in an hour, or 30 to 40 
in a day. More civil medical practitioners were employed 
when necessary, and, in order to ensure greater care and 
thoroughness, civil medical practitioners were required to agree 
as a condition of their employment to the 2s. 6d. fee being 
withheld or recovered in the case of each recruit discharged 
as medically unfit after joining.* For this purpose commanding 
officers and medical officers of units were instructed to inspect 
each recruit on joining in order to discover if he were suffering 
from any gross disability and not likely to become an efficient 
soldier. 

Notwithstanding these measures, the results of the medical 
examination of recruits continued to be unsatisfactory ; and 
men were still being discharged from the army with less than 
three months' service or sent back as unfit from the expedi- 
tionary force, the chief disabilities from which they suffered 
being hernia, varicose veins, defective vision, deficient teeth, 

* In February, 1915, the maximum fee for a full day's work was limited to 
2 ; but as this represented only 16 examinations at 2s. 6d. each, the capita- 
tion grant of 2s. 6d. did not induce an examiner to examine up to the number 
of 40 daily. This was rectified in March, 1915, by a tariff of payments allow- 
ing 2s. for each recruit up to four, 10s. for examining nine recruits, 20s. 
for examining 19, 30s. for 29, and the maximum of 40s. for 30 or more. 
The penalty of withholding or recovering the fee was modified in June, 1915, 
and only enforced when the D.D.M.S. of the command considered that there 
was distinct carelessness on the part of the medical practitioner. 



120 MEDICAL HISTORY OF THE WAR 

middle-ear disease, debility and old age. In December, 1914, 
orders were consequently issued for an inspection of all trained 
soldiers and recruits in the United Kingdom, and medical 
inspectors of recruits were instructed to visit the chief recruiting 
centres in their command and satisfy themselves as to their 
general suitability, ascertain whether the tests of physical 
fitness were being adhered to, see that no medical officer was 
examining more recruits in a day than could be properly 
examined, and personally examine all recruits rejected under 
three months' service. 

Although pressure on recruiting medical officers had for the 
most part ceased by March, 1915, there was much lack of uni- 
formity in the standards of selection, and an effort was made 
to secure uniformity of standard amongst reinforcement drafts 
by appointing standing medical boards in all stations where 
there were units furnishing drafts for service abroad. Instruc- 
tions for the formation of these boards were issued on 3rd 
March, 1915. Each board consisted of two or three medical 
officers, one of whom was to be a regular officer of the R.A.M.C, 
not below the rank of captain. They were to examine all men 
reported by the unit as unfit for service abroad and classify 
them as 

A. Fit for service at home or abroad. 
B. Temporarily unfit for service abroad. 
C. Fit for service at home only. 
D. Unfit for service at home or abroad. 

This was the beginning of classification according to medical 
fitness, from which the various categories under the Military 
Service Act were subsequently evolved. 

These boards did not, however, replace the medical exami- 
nation of recruits by civil medical practitioners throughout the 
country, who continued to examine recruits as before ; but 
another description of medical board, the Travelling Medical 
Board, was established in July, 1915, with functions very similar 
to those of the standing medical boards. Travelling medical 
boards were appointed originally for the purpose of inspecting 
and classifying all men reported by local medical officers as 
permanently or temporarily unfit for foreign service, and any 
others who, for medical reasons, were not included in drafts 
for overseas. Men who were reported locally as permanently 
unfit for military service, but whom a travelling medical board 
considered fit for some kind of service, were to be removed 
from the category of permanently unfit and re-classified in the 
same manner as they were classified by the standing medical 
boards. In fact, travelling medical boards appeared then to- 



EXAMINATION OF RECRUITS 121 

have been instituted as boards for the revision of the work of 
the standing medical boards or for supplementing them. The 
situation, however, was by no means clear and had subsequently 
to be explained to commands in a War Office letter of the 
2 1st September, 1915,in which the functions of travelling medical 
boards were denned as being mainly for controlling and dimin- 
ishing the large numbers of men returned as unfit for duty, and 
for classifying the remainder in the categories already indicated 
in their original constitution. On the 3rd September, 1915, 
for example, the attention of the commands was drawn to the 
fact that throughout the country a total of 15,801 men, who 
had been more than sixty days with their units, had been 
returned as temporarily unfit. Certain units had as many 
as 250. Commands were then instructed to establish treatment 
centres for these men, and, if necessary, to engage masseurs 
and masseuses with systematic arrangements for continuous 
treatment under the supervision of the medical officer in charge. 
It was out of these treatment centres that the conception of 
command depots appears to have developed. 

Standing medical boards were to continue the primary in- 
spection, and the travelling medical boards, while co-ordinating 
and superintending the work, were only to see the men whom 
the standing medical boards returned as unfit for full duty, or 
such numbers as they might direct should be brought before 
them. It was not anticipated that the travelling boards would 
be able to inspect all men reported unfit, and it was suggested 
that they should inspect batches as test cases in order to evolve 
a uniform standard of unfitness and ensure that all temporarily 
unfit men in reserve units or doing light duty in depots should 
be made fit for drafts in the shortest possible time. The boards 
were to report on the time when temporarily unfit men would 
be likely to be fit, that is to say, within a month, within two 
months, within six months, or not until after six months. 

A travelling medical board was thus a more authoritative 
board than the standing medical board. It consisted of two 
medical officers of senior rank and a combatant officer of the 
rank of colonel or lieut. -colonel. At first two such boards 
were appointed to the Eastern, Southern and Northern 
Commands, and one to each of the other commands, but their 
number was subsequently considerably increased. 

During the period of voluntary enlistment in 1915, this 
system of medical examination and supervision of recruits and 
men regarded as unfit for drafts thus became somewhat in- 
volved. There was first of all examination of the recruit by 
a civil medical practitioner, supervised by a medical inspector 
of recruits and reviewed by the commanding officer and medical 



122 MEDICAL HISTORY OF THE WAR 

officer of the unit to which the recruit was sent. Then there 
was classification by a local standing medical board of recruits 
and all men returned by the unit as medically unfit, followed 
by a further inspection and classification of them by a travelling 
medical board under the administrative supervision of the 
D.D.M.S. of the command. 

It was evident that a system of this kind could not continue. 
It failed in its endeavour to attain uniformity of standard in 
the various categories, and was frequently the subject of public 
criticism. The first step towards reform was taken in December, 
1915, after Lord Derby became Director-General of Recruiting. 
Medical examination of recruits by individual civil medical 
practitioners was then abolished and replaced by examination 
by recruiting medical boards, consisting of a president and three 
or four members. The president was to be a regular officer of 
the R.A.M.C., if possible ; the other members were to be selected 
civil medical practitioners, who had gained experience in 
recruiting. Recruiting medital boards assembled at each 
regimental depot and at the central recruiting office of each 
of the recruiting areas. In city areas there were two such 
boards. 

The classification of men called up for service was then made 
more extensive. Five main categories with sub-categories 
were introduced as follow : 

(1) Fitness for general service ; 

(2) Fitness for field service at home ; 

(3) Fitness for garrison service : 

(a) abroad, 

(b) at home ; 

(4) Fitness : 

(a) for labour, such as road-making, entrenching 

and other works, and : 

(b) for sedentary work only, such as clerical work ; 

(5) Unfitness for any military service. 

Travelling medical boards revised the classification, when 
necessary, and were the authority by which a recruit's category 
after he had been attested could be lowered ; but the standing 
medical boards were not abolished, although it is not quite clear 
in what way they were employed except to supplement the 
work of the travelling medical boards. 

In 1916 the Military Service Acts came into force ; the first 
in January providing for compulsory service of unmarried men 
between the ages of 18 and 41, and the second in May, making 
these provisions applicable to married men. They led to several 
changes in the medical classification of recruits, and also 



EXAMINATION OF RECRUITS 123 

extended the new system of classification to all serving 
soldiers and men sent home sick and wounded from an 
expeditionary force or garrison abroad. These changes took 
place in June, and were followed by the abolition of the 
standing medical boards the same month and of the medical 
inspectors of recruits in August following, the latter becoming 
presidents of additional travelling medical boards which had 
practically assumed their functions. 

The new classification was that of the lettered categories, 
which afterwards became so widely known throughout the 
Empire. Each of the lettered categories had sub-numbers and 
were as follow : 

Category A. Men fit for general service, i.e., able to 
march, see to shoot, hear well, and stand active 
service conditions. 

(i) Men fit for despatch overseas in all respects 
as regards training and physical and mental 
qualifications, 
(ii) Recruits who should be fit for category Ai 

when trained. 

(iii) Men returned sick or wounded from an 
expeditionary force who should be fit 
for Ai when hardened.* 
(iv) Recruits under 19 years of age.j 
Category B. Fit for service abroad, but not for general 
service ; i.e., free from serious organic disease, and 
able to stand service conditions on lines of 
communication in France or in garrisons in the 
Tropics. 

(i) In garrison or provisional units. 

(ii) In labour units, or in garrison or regimental 

outdoor employment, 
(iii) On sedentary work as clerks and storemen 

only. 

Category C. Fit for service at home only ; i.e., free from 
serious organic disease, but only able to stand 
service conditions in garrisons at home. 

* Hardening of a man discharged from hospital to his reserve unit consisted 
of marching for the first week without arms for 1 mile morning and afternoon ; 
for the second week, 2 miles quick march, morning and afternoon ; for 
the third week, 4 miles morning and afternoon under the same conditions ; 
in the fourth week, full duty ; in the fifth week, ready for drafts. A man 
discharged from a command depot or convalescent hospital to his reserve 
unit was placed at once in Category Ai. 

f This sub-number was added on the 21st June, 1916. 



124 MEDICAL HISTORY OF THE WAR 

Category C cont. 

(i) In garrisons or provisional units. 

(ii) In labour units or regimental outdoor 

employment. 

(iii) On sedentary work as clerks, storemen, bat- 
men, cooks, orderlies, and on sanitary 
duties. 

Category D. Men temporarily unfit for Categories A, 
B, or C. 

(i) In command depots, 
(ii) In regimental depots. 
*(iii) In any unit or depot under or awaiting 

medical or dental treatment. 

Category E. Men unfit for service in Categories A, B, 
or C, and not likely to be fit within six months. 

As regards the classification of men in the sub-numbers of 
categories B and C, the categories Bi and Ci were intended 
for men able to march at least 5 miles, see to shoot without 
glasses, and hear well ; Bii and Cii for men able to walk not 
more than 5 miles to and from work, and to see and hear 
sufficiently for ordinary purposes ; and Biii and Ciii for men 
suitable for sedentary work only. 

Men from overseas who were discharged to duty from hos- 
pital were classified (1) as fit for general duty, in which case 
they went to their reserve battalion as Ai, or (2) fit for light 
duty and likely to be fit for drafts in three months, when they 
went to the regimental depotsf as Aiii, or (3) fit for light duty 
but not likely to be fit for drafts in three months or requir- 
ing some special medical treatment, when they went to a 
command depot as Bi; or unlikely ever to be fit for drafts, 
when they went to a reserve or provisional battalion, as Bi 
or Ci. 

A man considered unfit for further service by the medical 
officer in charge of a unit came before a travelling medical 
board which classified him in any of the above categories or 
discharged him from the service. Travelling medical boards 
had also to examine and classify or discharge from the service 
all men who were more than six months in category D, and 
see all soldiers not classed in category A, as well as those con- 
sidered by the medical officer of the unit as unfit to remain in 
that category. 

* This was a temporary category for men of higher category in reserve 
units. They automatically rejoined their original category after their treat- 
ment was finished. 

t In the case of T.F. men, to a command depot. 



EXAMINATION OF RECRUITS 125 

The results of this new system were more or less satisfactory, 
although differences in standards adopted by different recruit- 
ing medical boards did not cease to become a source of difficulty 
and complaint. The responsibility of the D.D.M.S. of com- 
mands for visiting boards and maintaining a uniform standard 
was emphasized but the task was impossible under the 
circumstances, and the number of men who complained of the 
category in which they were placed was considerable. To 
deal with such complaints, appeal tribunals had been set up by 
the Local Government Board, and in October, 1916, a special 
medical appeal board* was established at the Royal Army 
Medical College in London, to re-examine and classify men, 
whom the tribunals considered should be re-examined on medical 
grounds. An independent inspector of recruiting medical 
boards in the department of the Director-General of Recruiting 
at the War Office was also appointed, in November, 1916, to 
establish throughout the country uniformity in the medical 
examination of recruits. Colonel J. Galloway, R.A.M.C. (T.F.), 
was entrusted with the duties. He had been recalled for 
this purpose from France, where he held the appointment 
of consulting physician to the 1st and 2nd Armies. 

After an inspection of the work of boards he submitted 
a report to the Director of Recruiting emphasizing the need of 
better accommodation for medical examinations and suggesting 
a scheme of examination by team work.f instead of by one 
member undertaking the whole examination of a single recruit. 
Instructions to this effect were issued in February and again 
in August, 1917. Travelling medical boards, as originally con- 
stituted, were abolished and reconstituted at the beginning of 
1917 to consist of a permanent president, the senior medical 
officer of the station where the board happened to be sitting, 
and the medical officer and the commanding officer of a unit 
which was not being examined. Their functions remained 
much the same as before. 

On the 5th April, 1917, the Military Service (Review of 
Exceptions) Act came into force. It was the subject of 
a long Army Council Instruction, issued in the same month, in 



* The board sat under tne presidency of Colonel Lynden-Bell, A.M.S., and 
consisted of two temporary R.A.M.C. officers, two civil medical practitioners, 
two consulting surgeons, and two consulting physicians. In March of the 
following year similar boards were appointed at Leeds and Edinburgh, and 
in July, 1917, an additional appeal board was established in London. 

f Team work meant the examination of a recruit by each member of the 
board in rotation ; the first examiner confining himself to the eyes, ears and 
teeth, the second to the limbs and joints, the third to the external parts of 
the body, and the fourth to the chest and internal organs, while the president 
completed the necessary documents and classified the recruit. 



126 MEDICAL HISTORY OF THE WAR 

which an endeavour was made to explain the complicated 
nature of the Act and the procedure to be followed in giving 
effect to it. It was anticipated that some 950,000 men 
who had previously been exempted- would be called up for 
examination under the Act. The Act was unpopular and its 
application raised a storm of hostile criticism in and out of 
Parliament, directed mainly against the manner in which 
medical examinations and re-examinations were being carried 
out, and against the methods and standards adopted in 
classification of recruits. 

The army medical administration and the medical profession 
as a whole had been set a task which was medically and 
physically impossible to carry out accurately and well. All 
kinds of accusations were brought against the recruiting 
medical boards. It was asserted that blind, maimed and 
crippled were being passed into the army ; that the examina- 
tions were hurried, casual and perfunctory ; that there was lack 
of courtesy on the part of members or presidents of certain 
boards and that they ignored the certificates of family doctors ; 
that presidents categorized recruits without reference to other 
members of the board ; that men were kept for hours waiting 
examination or were, during examination, left stripped of 
clothing for unnecessarily long periods. In fact, it was felt 
generally that the unpopular Military Service Acts were 
being carried out tactlessly and that the irregularities and 
apparent inconsistences of the medical examinations and 
re-examinations were having a bad effect on the national 
temper. 

Isolated instances no doubt occurred in which the pro- 
cedure of a medical board was responsible for the widespread 
feeling of resentment against the medical examinations gener- 
ally; but most of the trouble arose from the system of 
registration and calling up of recruits, and the fraudulent 
practices which arose in connection with impersonation, 
doping, and other means, adopted to escape military service. 
A military register had been formed in connection with the 
National Registration Act, which was passed as long ago as 
August, 1915. It was a register which in its very essence could 
never be kept up properly, and in May, 1916, Sir Auckland 
Geddes, when he became Director of Recruiting, found approxi- 
mately 1,000,000 errors in it; but, owing to the errors, many 
cases occurred of men being called up wrongly or unnecessarily. 
Fraudulent practices occurred in the sale of rejection certifi- 
cates, and it is on record that it became an industry to turn 
out forged War Office classification cards. Impersonation was 
of frequent occurrence. One form of it was peculiar. When 



127 

a man who was stone blind or who had two wooden legs was 
called up, a man in perfect health appeared for medical ex- 
amination in his place and was passed fit, the name entered 
being that of the blind or cripple and not of the man examined, 
so that when the latter was called up in due course as having 
been examined and passed fit for general service the calling- 
up notice went to a blind or crippled man who reported for 
service in his place. Instances like this could not fail to excite 
popular comment on the work of the military medical boards, 
and civil medical practitioners were losing prestige in the 
localities where they practised by being members of such 
boards. Men also arrived before the medical boards with 
rancid oil, condensed milk, or some other substance running 
from their ears in order to deceive the medical officers. 
Everything, in fact, was being done to make the work of the 
medical boards as difficult as possible. 

But whatever else may have roused popular feeling against 
the manner in which the Military Service Acts were being 
applied by the recruiting authorities and medical boards, the 
method of categorizing recruits, and the impossibility of main- 
taining a definite standard for each category were probably the 
chief cause of discontent. Medical boards were required to 
classify a man, not in accordance with his actual state of health 
at the time of his examination, but in the category of fitness 
which he was likely to attain after four months' military 
training. It was hardly possible to expect medical boards or 
their individual members to be in agreement on this point in 
each case. In fact, " the doctrine of disagreement of doctors 
applied to disagreement of boards." Then, again, the policy 
which the boards were instructed to follow was that if a man 
were fit to earn his living as a civilian he was also fit to do 
some form of work in military service. There was probably 
no greater source of trouble than the interpretation placed by 
medical boards on this. 

These difficulties in arriving at a uniform standard of classifi- 
cation are exemplified by the result of the re-categorization of 
3,449 men who appeared on appeal before the special medical 
board in London between October, 1916, and 4th July, 1917. 
The category of 189 of them was raised, 1,202 were confirmed 
in the category in which they were placed by the recruiting 
medical boards, 1,958 were lowered, and 336 rejected as unfit. 
As many as 135 of the 336 rejected had been placed by the 
recruiting medical boards in Category A. The majority of the 
rejections were for nervous disorders, tuberculosis and heart 
disease. These facts, and similar facts produced by the appeal 
tribunals, led to the popular impression that an immense 



128 MEDICAL HISTORY OF THE WAR 

amount of hasty and ill-considered classification of men for 
the army was going on. On the other hand, the Director of 
Recruiting, Sir Auckland Geddes, tested the margin of error 
in classification in a sample case, and found that it did not 
amount to more than O5 per cent, of the total number of 
recruits classified. 

All these points and many others led to a debate on the Army 
estimates on the 21st June, 1917, and subsequent days, in 
which attention was drawn to the alleged scandals in connection 
with the medical re-examination of discharged and rejected 
men. It was stated that " the appeal tribunals had long since 
lost any faith not only in the competence, but in the good faith 
of some of the medical boards." It was pointed out in reply 
that the medical boards were not so much to blame ; that 
medicine was not an exact science, and that results which they 
were not capable of affording were being asked for in vain 
from medical examinations. Further, many men who had 
been rejected under the old system and were being called up 
for re-examination under the Military Service (Review of 
Exceptions) Act had been previously rejected in primary 
military examinations without being brought before a medical 
officer, or were rejected by certain selected corps to which they 
were posted, or had obtained rejection by fraud, bribery, im- 
personation, doping, or chemical and bacterial maiming ; so 
much so, that in one city alone, as many as 25 per cent, of 
rejected men proved on re-examination to be Category A men. 
The men who came up in these circumstances were often very 
critical in speaking of their medical examinations. 

In order to restore public confidence a select committee of 
the House of Commons was appointed on the 26th June, 1917, 
to enquire and report on the instructions issued by the War 
Office with regard to the administration of the Military Service 
(Review of Exceptions) Act, 1917, and on the method, conduct 
and general administration of the medical examinations under 
the Military Service Acts. 

The committee commenced its sessions on the 27th June, 
under the chairmanship of Mr. Shortt, and examined, amongst 
others the Director of Recruiting, the Director-General of 
the Army Medical Service, the Deputy Directors of Medical 
Services of different Commands, the Inspectors of medical 
boards, certain members of recruiting medical boards and 
special medical appeal boards, the G.O.C.-in-Chief of the 
Northern Command, members of tribunals and military 
tribunals and others, as well as the Secretary of State and 
Under-Secretary of State for War. Before completing the 
examination of all of these witnesses, the committee sub- 



EXAMINATION OF RECRUITS 129 

mitted a special report on the 2nd August, 1917, recommending 
that the whole organization of recruiting medical boards and 
of the medical examinations and re-examinations should be 
removed from the War Office and placed under civilian control* 
at the earliest possible moment, and not delayed until the full 
report was presented.! 

In consequence of this report the system of medical exami- 
nation of recruits was radically changed. The Ministry of 
National Service was reconstituted on the 31st October, 1917. 
Sir Auckland Geddes, the Director of Recruiting, was trans- 
ferred to it as its head, and Colonel Galloway reverted to civil 
employment and joined the Ministry as its Chief Commissioner 
of Medical Services. A medical advisory board was also estab- 
lished in connection with the medical department of the 
Ministry of National Service. It consisted of representative 
medical men of high standing from England, Scotland and 
Wales, to advise the Chief Commissioner in matters of technical 
medical concern, such as the disabilities which should determine 
the grading of men.| 

The whole system of recruiting was then reorganized on 
a civilian basis. The country was divided into ten recruiting 
regions, which, with the exception of Scotland, did not coincide 
with the areas of the military commands. A director of re- 
cruiting and a commissioner of medical services were appointed 
amongst other officials to each region for the purpose of col- 
lecting men from civil life, sending them before the medical 
boards, and arranging and controlling medical boards generally. 
The regions were each divided into a considerable number of 
areas, with a deputy commissioner of medical services in each 
area who presided at all sessions of medical boards in the area. 
The medical boards were formed of the chairman and four 
members obtained as required from a panel of the local civil 
medical practitioners, who gave part time service in rotation 

* This was the view held in 1916 by the Adjutant-General, Sir Nevil 
Macready, who recorded his opinion then that the collection of men for 
military service should be a civil function under the Home Office or Local 
Government Board, and that the War Office should only control their 
reception. The War Office had frequently pressed for a co-ordinating 
department but this was refused by the War Cabinet. 

f The full report was not submitted till the following year, the last session 
of the select committee being held on the 31st January, 1918. 

J The medical departments of the Admiralty, War Office, Local Govern- 
ment Board, Scottish Office, National Health Insurance Commissioners, and 
Ministry of Pensions were notified of all meetings of the Advisory Board and 
could send representatives to them. 

Areas corresponded roughly with county boundaries, but in large cities, 
such as Manchester, there were more than one area with a deputy commissioner 
in each. 

(1735) K 



130 MEDICAL HISTORY OF THE WAR 

either at a forenoon or afternoon session.* In addition, a 
number of travelling medical boards were established for the 
convenience of certain large industrial concerns such as col- 
lieries. They were supplied with portable equipment and 
travelled from place to place as required. f The whole system 
was entirely civil, and, although many of the presidents and 
members of the old recruiting medical boards constituted the 
new boards, none of them were army medical officers on the 
active list. Those on the retired list who had been re-employed 
by the military authorities reverted to civil employment. 

The special medical appeal boards ceased to exist on the 
31st October, 1917, and were replaced by medical assessors 
appointed to the appeal tribunals of the Local Government 
Board. The assessors, who were physicians or surgeons of high 
standing in the locality where the appeal tribunals sat, served 
in a purely civil capacity and formed groups of three medical 
men each. There were eleven such groups in England and 
Wales and three in Scotland, thus extending very widely the 
facilities for the re-examination of men who appealed to the 
tribunals for exemption or alteration of their classification. 

The Ministry of National Service, in taking over recruiting 
for the army, abolished, so far as the medical boards were 
concerned, the classification of recruits into categories of fitness 
for different kinds of military service. Instead, recruits were 
classified in four numbered grades according to their physical 
condition. 

Grade I included men who had attained the normal 
standard of health and strength, and were capable of 
enduring the amount of physical exertion suitable to 
their age, and were free from serious organic disease 
or deformity. Men in this grade were generally men 
fit for general service, and when handed over to the 
military authorities would be placed in Category A of 
the military administrative classification. 
Grade II included those who were able to stand a fair 
amount of physical strain and likely to improve under 
training. They were men with fair sight and hearing, 

* In London and in some other localities it was more convenient to have 
the boards formed of medical practitioners who gave their whole time to the 
duties. The number of these National Service Medical Boards was 97 in 
November, 1917, by June, 1918, there were 209. They examined 80,000 
men in the first month of their constitution, the number gradually increasing 
to 285,361 in April, 1918, 456,599 in May, and 475,416 in June. The number 
examined then gradually decreased. The total numbers examined between 
November, 1917, and October, 1918, inclusive were 2,425,184. 

f Similar recruiting travelling medical boards were used by the military 
authorities previously. 



EXAMINATION OF RECRUITS 131 

of average muscular development, and able, when 
trained, to march 6 miles with ease. They would be 
placed in Category Bi or Ci by the military authorities. 
Grade III included men not likely to be suitable to 
undergo military training for combatant service. They 
would be men suffering from defects or disabilities in 
varying degrees. The grade was intended to cover all 
men fit for auxiliary military service, either in the form 
of labour or sedentary occupation, the latter being those 
who for any reason were unable to walk a distance 
of 5 miles. It included the older men who were fit 
for work in camps rather than with moving troops. 
Men so graded were suitable for categories Bii and Cii, 
Biii and Ciii, when called up for military service. 
Grade IV included all men who were clearly found to be 
permanently and totally unfit for any form of military 
service by unanimous decision of the medical board 
or the medical assessors of an appeal tribunal. The 
grade was equivalent to category E of the old recruiting 
medical boards. 

Recruits were handed over to the military authorities as 
graded by the National Service medical boards, and these 
gradings could not be altered. But they were placed in the 
military categories which corresponded with the grades and 
posted to units accordingly. Subsequent lowering of the cate- 
gory could only be carried out by the travelling medical boards, 
which exercised their functions as before. But recruit distri- 
bution battalions* were formed for the reception of recruits 
handed over in Grade III. The functions of these battalions 
were to post to units, or otherwise dispose of, all Bii and Biii 
recruits, and to put through a course of physical training those 
belonging to these categories who were likely to attain to 
Category Bi within three months, when they were posted 
according to results. A posting board, composed of a field 
officer belonging to the battalion, the medical officer and a 
posting officer, carried out the posting of these recruits. 

Regional commissioners of medical services also provided 
pensions medical boards consisting of a chairman and two 
members. These boards were intended to sit in the same 
place as the recruiting medical boards, but with the accom- 
modation arranged in such a manner as to avoid pen- 
sioners mixing with recruits. Standard accommodation for 
a recruiting and pensions board, as arranged by the Ministry of 
National Service, is shown in the following alternative plans. 

* Formed in November, 1917, one in each command. 

(1735 K 2 



132 



MEDICAL HISTORY OF THE WAR 



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EXAMINATION OF RECRUITS 133 

In July, 1917, the Military Service (Convention with Allied 
States) Act was passed, and conventions were concluded with 
Russia the same month and with France on the 5th October, 
1917. They were made applicable by Orders in Council in 
August and September following, and provided for the exami- 
nation as to fitness for military service of British subjects resident 
in those countries. There is no record of examinations in 
Russia, but, in France, British residents were at first examined 
by military medical boards, and it was arranged that those 
passed fit for service should be examined by a National Service 
medical board at Southampton, on their arrival in England. 
This arrangement proved unsatisfactory, in consequence of 
the wide divergence of opinion between the military and civil 
boards. The Ministry of National Service thereupon undertook 
to provide a civilian medical board to examine British subjects 
in Paris ; and this board subsequently became a travelling 
medical board, which visited other localities in France where 
British subjects resided. A similar board was formed in 
Dublin in July, 1918, to examine Englishmen resident in 
Ireland. These boards completed their work between July and 
September, 1918. 

With the transfer of the medical examination of recruits to 
the National Service Ministry the work of the Army Medical 
Service in respect to this duty came to an end ; but military 
and National Service medical boards came into association 
with one another in connection with the discharge of soldiers 
from the army. In order to centralize the method of dis- 
charging men, especially men of low category, who had accumu- 
lated in large numbers in the army, a permanent discharge 
centre was established in each command in December, 1917, 
where discharges or transfers of soldiers to the reserve, other 
than patients in hospital who were discharged by hospital in- 
validing medical boards as permanently unfit, were carried out.* 
But all men sent to the discharge centre from their units had 
to be brought before a military medical boardf to determine 
whether they were physically fit or unfit for further service ; J 



* Previous to this similar cases were transferred to a labour unit in each 
command and discharged from there. 

t In July, 1917, a standing invaliding board was appointed to each labour 
centre for the purpose of classifying or discharging men sent to it from units 
by commanding officers as unfit for further service. The discharge centre 
boards replaced these. The men sent to the standing invaliding boards did 
not come before travelling medical boards. 

J Large numbers of men, such as miners and shipbuilders, were sent to 
the discharge centre for discharge from the army to take up civil work of 
national importance. They were not necessarily unfit for military service 
and might belong to the highest category. 



134 MEDICAL HISTORY OF THE WAR 

and civilian medical boards established by the National Service 
Ministry had then to determine whether the soldier had or had 
not been impaired in health since his entry into the army and 
to place him in the civil grade for which they considered him 
fit. The establishment of both military and civil boards at the 
discharge centre resulted in duplication of work and waste of 
medical personnel, and in August, 1918, it was decided by the 
Army Council in agreement with the Ministry of Pensions and 
the Ministry of National Service to establish only one type of 
board at each discharge centre. It was to be a civilian medical 
board of two medical practitioners from the National Service 
panel with one military medical officer attached, under a deputy 
commissioner of medical services as chairman. Any dis- 
agreement between the civilian and military members was to 
be referred to an appeal board. 

The systems of medical examination of recruits established 
after the passing of the Military Services Acts may be said 
thus to have effected for the first time in the history of Great 
Britain an enquiry into the physical health of the whole male 
population of military ages throughout the country, and new 
and important facts regarding the physical standards of the 
nation's manhood were brought to light. As regards the 
military medical service, the importance of dentistry in the 
army and the significance of cardiac symptoms were strongly 
emphasized. 

Very many recruits appeared for voluntary enlistment at 
the beginning of the war who were being rejected on account 
of defective teeth, and who with suitable dental treatment 
would have been accepted for general service. At first there 
was a tendency to relax the dental standard, but instructions 
on this point had to be cancelled, owing to the bad state of 
teeth of men sent as drafts to units in the field. The British 
Dental Association, the Scottish Dentists' Association, 
dental surgeons and dental institutions throughout the country 
volunteered to treat gratuitously the men rejected on account 
of such dental defects as could be rectified in order to render 
them fit for service, and in this way materially assisted recruit- 
ing. Early in the war arrangements were made by the War 
Office with the British Dental Association by which a medical 
officer examining recruits was empowered to send men whom 
he considered could be made fit by dental treatment to dental 
surgeons and dental institutions in the neighbourhood of the 
recruiting office. In November, 1914, commands were also 
asked to prepare a list of dentists of high standing who would 
be willing to act as honorary consultants in dental surgery to 
the military hospitals. Instructions were issued in the same 



EXAMINATION OF RECRUITS 135 

month to the effect that no man was to be discharged on account 
of decay or loss of many teeth if by dental treatment he could 
be rendered fit to remain in the service ; full advantage being 
taken of the facilities placed at the disposal of commands for 
gratuitous treatment. Later on, in January, 1915, men with 
defective teeth might be attested if otherwise fit for general 
service and willing to undergo dental treatment; and in 
February of the same year a recruit might be passed as fit 
"subject to dental treatment," which was then to be carried 
out when he joined his depot. 

The dental work which was thus introduced into the army 
led at a very early period of the war to the recognition of 
dentistry as a special branch of army medical organization and 
of special importance in connection with recruiting. There was 
at first a slow but steady increase in the number of dentists 
appointed to special commissions both for service at home and 
overseas. Twelve were sent to France in November, 1914, and 
the number was increased to twenty in December, but, at home, 
dental treatment remained in the hands of civil practitioners, 
until towards the end of January, 1915, when a few commis- 
sioned dentists were posted to home stations for the treatment 
of recruits and serving soldiers, but they were so few that practi- 
cally the whole of the work was still carried out by civil dentists, 
many of whom were unqualified practitioners whose work there 
were no means of effectively controlling. The result of this 
was that many men had their teeth extracted unnecessarily 
and were held back from drafts until their mouths were ready 
for dentures. Other difficulties arose in connection with the 
refusal of men, who had been passed into the army, to undergo 
dental treatment, and the necessity of appointing inspecting 
dental officers was forced on the administrative medical services 
in August, 1915, with the result that in September of that year 
commands were authorized to select a suitable dental officer, 
from amongst those serving in the command, who should be 
on the staff of the D.D.M.S. and advise on all dental matters. 
The shortage of commissioned dental officers, however, impeded 
their work to a considerable extent ; and when the Military 
Service Acts of 1916 came into force a large increase in the 
number of military dental surgeons became necessary. The 
numbers gradually increased to 463 in December, 1916, and 
continued to increase year by year till it reached a maximum 
of 849 at the time of the Armistice in November, 1918.* 

During 1916 and 1917, notwithstanding these efforts at estab- 
lishing a high standard of dental treatment amongst recruits, 

* In February, 1915, the number was 36, in May, 1915, 57, in August, 1915, 
150, and 300 in August, 1916. 



136 MEDICAL HISTORY OF THE WAR 

administrative difficulties arose in many directions, and it was 
with a view to advising and co-ordinating the work throughout 
the United Kingdom that an inspecting dental officer was 
appointed to the staff of the Director-General of the Army 
Medical Service at the War Office in March, 1918. Lieut.-Colonel 
Helliwell, after taking up the appointment and inspecting the 
dental work in the commands, submitted a long report to the 
War Office in May of that year. He stated that the dental 
treatment at home was quite inadequate and that only a 
very small proportion of the men requiring dental treatment 
were being made dentally fit for service abroad.* He estimated 
that the number of men at home liable to service overseas 
who required dental treatment each month was 136,150, and 
that the number of dental surgeons required was 667, exclusive 
of 100 required for the Royal Air Force. The number of dentists 
in the home commands was at that time 282, and, in consequence 
of this report, the number was increased in October to 690. 
Lieut.-Colonel HelliwelTs report contained many other details 
and suggestions for army dental organization and treatment. 
They were eventually embodied in an Army Council Instruc- 
tion of October, 1918. The dental condition of the drafts for 
overseas steadily improved as a result of this evolution of 
the dental services, and, as already noted, dentistry has now 
become recognized as an integral part of the military medical 
organization. 

Another result of the extension of recruiting to all classes of 
the community was to introduce into the army men whose 
vision was lower than the standard accepted previous to the 
war, and with this came an organization for the provision of 
spectacles through ophthalmic centres. Thusin February, 1917, 
the vision of a man passed into Category A, which formerly 
had to be one-fourth of normal vision in both eyes without 
glasses, was only required to reach that standard in one eye, 
provided the vision in the other eye could be corrected to one- 
half normal vision with the aid of glasses. But the issue of 
spectacles was authorized long before this in an instruction of 
March, 1915, in which every man proceeding overseas, whose 
eyesight would be improved by glasses, was to be provided 
with two pairs of spectacles ; an instruction which was re- 
peated in November of the same year to apply to every 
soldier liable for active service who was in need of spectacles. 

The significance of cardiac symptoms in connection with the 
rejection or otherwise of men appearing before medical examiners 
of recruits, recruiting medical boards and special medical 

* 70 per cent, of the recruits and men at home were estimated to be in 
need of dental treatment. 



EXAMINATION OF RECRUITS 137 

appeal boards became a matter of much importance. Many 
men had been and were being rejected on account of supposed 
heart disease, who, in accordance with the teaching of Sir 
James Mackenzie, the recognized authority on the subject, 
were perfectly fit. At the request of the War Office he drew up, 
in September, 1915, a memorandum, for the guidance of medical 
examiners of recruits, dealing with the significance of abnormal 
signs in the recruit's heart, such as were physiological in origin 
and indicative of neither disease nor impairment. It is difficult 
to ascertain the extent of the influence which this memorandum 
exercised on the rejection of recruits ; but Sir James Mackenzie, 
in his evidence before the select committee of the House of 
Commons referred to above, does not appear to have been 
impressed with the manner in which it operated on the minds 
of medical examiners. 

But whatever may have been their permanent effect on the 
army medical service, the general results of the medical 
examination of recruits under the Military Service Acts had 
a far-reaching effect. The facts elicited concerning the health of 
the civil population formed a human document which inspired 
to a great extent the organization subsequently formed after 
peace was declared to deal with the problems of public health 
in the United Kingdom. 



CHAPTER VIII 

THE RECRUITING AND TRAINING OF PERSONNEL FOR THE 
MEDICAL SERVICES 

THE recruiting of personnel for the Army Medical Service 
did not differ in its general aspects from the recruiting 
for the army generally, except in the case of officers and nursing 
services, for which special arrangements were made ; but, 
owing to the demands for men as reinforcements to the com- 
batant ranks, the recruiting for the Royal Army Medical Corps 
was restricted not only in numbers but also in categories as 
the war went on, and had to be supplemented in hospital 
services to a great extent by women. 

Active recruiting was carried on, however, without restriction 
until the 4th November, 1914, when 26,336 had voluntarily 
enlisted in the Royal Army Medical Corps.* Recruiting for 
the Corps was then stopped, but it was resumed between 8th 
January and 10th March, 1915, and again for a few days at 
the end of April and beginning of May of the same year. 
After the 3rd May, 1915, general recruiting for the Corps 
ceased altogether except for a short period between the 24th 
October and 4th November, 1915, during which time 8,639 
recruits were obtained. Enlistment in the R.A.M.C., however, 
was permitted to men with special qualifications, such as 
dispensers, laboratory attendants, nurses, masseurs, mental 
and operating room attendants, sanitary inspectors, splint 
makers, electro mechanics, and men holding first aid and 
nursing certificates. By the 31st December, 1915, 66,139 men 
had been obtained for the R.A.M.C., including the home 
hospital reserve, but exclusive of men in the Territorial Force. 

In the years of the war subsequent to 1915 enlistment into 
the R.A.M.C. was determined by the Military Service Acts. 
Although 6,700 recruits of the highest national service group 
were posted to the R.A.M.C. in the summer of 1918, men 
allotted to it, as is shown in the following tables, were chiefly 
men of a category of physical fitness lower than that required 
for combatant units, with the result that men of the highest 

* The sources from which recruits were obtained were from amongst 
men whose occupation in civil life was that of clerks, schoolmasters, and 
students of all descriptions, in addition to men with special qualifications 
and members of the St. John Ambulance Brigade. Some clergymen were 
also eager to enlist in the R.A.M.C. when debarred by episcopal authority 
from joining the combatant ranks at the beginning of the war. 

138 



RECRUITING OF MEDICAL SERVICES 



139 



category already in the Corps were gradually drafted into the 
field medical units ; their places in the medical units on the 
lines of communication and at home being taken by new 
recruits of lower categories, and by invalids from overseas 
discharged from hospital as unfit for general service, or by 
women. 

Posting of Recruits to the R.A.M.C. after the Military Service 
Acts came into Force, 



Month. 


Military Categories. 


Total. 


A. 


Bi. 


Bii. 


Biii. 


Ci. 


Cii. f Ciii. 


1916. 


















January . . 


100* 




















100 


February 


























March 


























April 


























May 


























June 


























July 


























August 


























September 








3,500 














3,500 


October . . 








3,500 














3,500 


November 








1,000 














1,000 


December 


























1917. 


















January . . 








4,000 














4,000 


February 








4,000 














4,000 


March 








1,550 














1,550 


April 





1,050 


4,000 





5,450 








10,500 


May 








2,400 





2,600 








5,000 


June 





500 


1,500 














2,000 


July 








4,000 














4,000 


August 





250 


3,500 





250 








4,000 


September 





500 


1,000 





500 








2,000 


October . . 


























November 





500 


1,500 














2,000 


December 



























Category 1 of A.C.I. 212 dated 26/1/16. 



Month. 


National Service Groups. 


Total. 


I 


II 


Ill 


1918. 










January 




















February 











500 


500 


1,000 


March 











1,000 


1,000 


2,000 


April 




















May . . 








3,200 


1,000 


700 


4,900 


June . . 








2,500 


500 


250 


3,250 


July .. 








1,000 








1,000 


August 




















September 




















October 




















November 




















December 





















140 MEDICAL HISTORY OF THE WAR 

Summary. 



1916. 


1917. 


1918. 


Group. 


No. 


Group. 


No. 


Group. 


No. 


A 






100 


A 









I 


6,700 


Bi 









Bi 






2,800 


II 


3,000 


Bii 






8,000 


Bii 






27,450 


III .. 


2,450 


Biii 









Biii 















Ci 









Ci 






8,800 








Cii 









Cii 















Ciii 


* 







Ciii 

















8,100 




39,050 




12,150 



The shortage of men of high category for the R.A.M.C. in 
the field began to be felt, however, in 1915, for in July of that 
year provision was made for the employment in hospitals at 
home of men of the regular and territorial force, who were 
permanently unfit for service abroad, in order to release men 
of the R.A.M.C. for medical units overseas. 

This shortage of high category men was accentuated by an 
order issued on the 23rd March, 1915, by which a number of 
men of the R.A.M.C. were transferred to infantry battalions 
to meet demands for reinforcements to the expeditionary 
force. To replace them, members of the R.A.M.C.(T.F.) 
between the ages of 17 and 19, or 40 and 50, that is, 
the too young and the too old for field service, were 
authorized in May, 1915, for enlistment in the R.A.M.C. 
if suitable for work in general hospitals, and men between 
the ages of 19 and 39 serving in the R.A.M.C.(T.F.) 
general hospitals, were encouraged to re-enlist in the 
regular R.A.M.C., or take on an imperial service obligation. 
A shortage of men was also felt in the home hospital reserve 
employed in the military hospitals at home when the great 
expansion of hospital accommodation began. It was con- 
sequently arranged, in May, 1915, to distribute men of the 
home hospital reserve to new military hospitals as a nucleus 
establishment, and then complete the establishments of all 
hospitals by young recruits of the R.A.M.C. 

In the case of war hospitals established in asylums and 
military hospitals in poor law infirmaries, the hospital personnel 
was obtained mainly from the civilian staff of these institutions.* 

* Some confusion arose at first from the fact that these civilian staffs 
were being paid from two sources, and in October, 1915, attention had to be 
drawn to diversity of practice in this respect, pointing out that all permanent 
civilian staffs, whether granted temporary army rank or not, or paid at 
civilian, army, or special rates, were to be paid by the civilian authorities of 
the institution and not direct from army funds. 



RECRUITING OF MEDICAL SERVICES 141 

The employment of women in military hospitals at home in 
order to replace non-commissioned officers and men transferred 
to other medical units commenced in September, 1915. A 
committee composed of several representatives of civil organiza- 
tions which were in a position to supply women for hospital 
duties was established by the Joint War Committee of the 
British Red Cross Society and Order of St. John. It was known 
as the Joint Voluntary Aid Detachment Committee, Devon- 
shire House, and arrangements were made by the War Office 
by which all demands for women for general service in hospitals, 
as distinct from nursing services, were to be made to the 
chairman of this committee.* Women were registered as dis- 
pensers, clerks, cooks, and cleaners, at weekly rates of payment 
varying from 18s. Qd. for a cleaner to 35s. for a head cook 
or head clerk and 30s. for a dispenser, with allowances of 4 
for dress. They were placed under the control of the matron 
when on duty in wards, and under the head cook when employed 
as kitchen staff. 

The arrangements were modified in January, 1916, and 
women employed in military hospitals were then engaged either 
as " general service women," or as " labour staff." The 
former class included clerks, telephonists, untrained laboratory 
assistants, and storekeepers, with weekly wages from 20s. to 
26s. ; women with special technical qualifications such as 
dispensers, at 40s. to 45s. weekly ;f cooks at 30 and 40 
annually if resident head cooks, or 16s. to 18s. weekly if 
assistant cooks ; trained laboratory assistants at 26s. to 30s. 
weekly ; and head clerks with wages ranging from 26s. to 33s. 
weekly, or 33s. to 35s. in the case of a head clerk appointed 
as a general superintendent. The officer commanding a hos- 
pital at home applied for the general service class of women 
to the county directors of voluntary aid organizations, in 
order that women living in their homes in the vicinity of the 
hospital should be obtained if possible. Failing these, parti- 
culars of requirements were sent to the Joint V.A.D. Committee 
at Devonshire House. The labour staff consisted of women 
on unskilled or semi-skilled work such as cleaners, scrubbers, 
kitchenmaids and others employed on manual labour. They 
were engaged locally, without reference to the voluntary aid 
organizations, by the officer in charge of the hospital or matron 
at 18s. to 20s. weekly without food or lodging. 

* Women cooks were, however, appointed to convalescent hospitals through 
the Commandant of the Women's Legion, Cookery Section, an organization 
not represented on the Devonshire House Committee. 

f Dispensers with less qualifications received 28s. to 30s. weekly. 



142 MEDICAL HISTORY OF THE WAR 

In April, 1916, the scale of subordinate personnel was 
regulated, so as to consist of two voluntary aid detachment 
nursing members,* two women cleaners and one male orderly 
in a ward of 50 to 70 beds under a nursing sister. 

In June, 1916, general duty and nursing orderlies were 
withdrawn from military hospitals at home, and members of 
the nursing section of voluntary aid detachments were then 
required to perform the same duties as probationer nurses in 
civil hospitals, such as sweeping and dusting wards, cleaning 
of ward tables, baths, sinks and ward utensils, sorting of linen, 
and so on, in addition to the nursing duties which they were 
considered qualified to perform. 

In August, 1917, further instructions were issued regarding 
the employment of women in the general service section of 
the voluntary aid detachments. No general service or labour 
woman was to be employed unless a soldier was relieved for 
other purposes ; four women clerks being considered the 
equivalent of three soldier clerks. The employment of general 
service and labour women was then greatly extended and 
applied to medical units overseas. The nature of their employ- 
ment was also altered to include not only dispensers, clerks, 
cooks and storekeepers, but also waitresses, pantrymaids, 
optician assistants, dental assistants, motor transport drivers, 
mechanics, and washers, with commandants, unit superinten- 
dents, general service superintendents, and quartermasters. In 
other words, the general scheme of employment of women in 
hospitals at home and overseas, other than for nursing duties, 
took the place of the Women's Army Auxiliary Corpsf so far 
as the medical services were concerned. 

The recruiting of general service V.A.D. women was continued 
under this scheme until December, 1918, when it ceased. The 
employment of masseuses, however, in the medical services 
was outside the V.A.D. (G.S.) organization, and was initiated 
by Mr. and Mrs. Almeric Paget in August, 1914, who established 
a corps of 50 skilled masseuses, under the personal control 
and supervision of Mr. Almeric Paget, Dr. Barrie Lambert, 
and the Hon. Miss Essex French. It was called the Almeric 
Paget Massage Corps, and commenced working in territorial 
force general hospitals in September, 1914, free of charge to 

* The general service women became distinguished from the V.A.D. 
nursing sections by the letters V.A.D.(G.S.). Members of the V.A.D. (Nursing 
Section) had already been taken into employment in the military hospitals 
early in 1915. They were appointed by the War Office and not locally. It 
was arranged then that each trained nurse could be replaced by two nursing 
members of a V.A.D. 

I The W.A.A.C. was officially authorized in July, 1917 ; none of its members 
were appointed to replace men of the R.A.M.C. 



RECRUITING OF MEDICAL SERVICES 143 

the public. The increasing demand for skilled masseurs and 
masseuses in military hospitals led to the enrolment of large 
numbers in this Massage Corps, and in September, 1915, the 
War Office arranged that it should in future be the sole source 
from which masseuses should be supplied.* In December, 1916, 
it was given the title of the Almeric Paget Military Massage 
Corps, and in May, 1917, it became a service paid by the War 
Office for duty in military hospitals, convalescent hospitals 
and command depots. In July, 1917, the employment of its 
members was authorized in hospitals overseas. The rate of 
pay for a masseuse was fixed at 2 10s. weekly without accom- 
modation, the head masseuse receiving 3 if ten or more were 
employed in any one hospital.^ 

These arrangements continued until January, 1919, when a 
definite military massage service was organized, with its head- 
quarters at the War Office. The members were placed in two 
categories, A and B, according to qualifications. In each 
category there were three classes mobile, immobile, and part- 
time. The grades were head masseur or masseuse, senior 
masseur or masseuse, and masseur or masseuse. They were 
prescribed a uniform with the letters M.M.S. in white on a blue 
ground on the hatband, and grade badges on the shoulder- 
straps. Altogether 3,388 masseurs and masseuses were enrolled 
during the war, and 2,000 were at work on the day the Armistice 
was signed. Approximately, the numbers employed after the 
Almeric Paget Massage Corps became the recognized source 
of supplying massage personnel for military service was, in 
January of each year, 900 in 1916, 1,200 in 1917, 1,500 in 
1918, 2,000 in 1919. During 1919 the numbers were neces- 
sarily much reduced, and at the end of the year the number 
was 600. 

Recruiting for the R.A.M.C. of the Territorial Force was 
carried out by the Territorial Force County Associations on 
a divisional basis during the period of voluntary enlistment ; 
men being appointed to second and third line field medical 
units and casualty clearing stations as these units were raised. 
It was not within the power of the Director-General, Army 
Medical Service, to control their movements without the con- 
sent of the Territorial Force directorate until November, 1915, 
when the control of the medical services of the Territorial 
Force was transferred to him. After the Military Service Acts 

* From June, 1917, onwards masseuses might, however, be employed 
locally for out-patients, any expenses incurred being recovered from the 
Ministry of Pensions. 

t In an orthopaedic hospital or sections of hospitals when 25 or more 
masseuses were employed the head masseuse received 3 10s. weekly. 



144 MEDICAL HISTORY OF THE WAR 

had been passed, officers and men under 41 years of age became 
available for posting where required, and existing Territorial 
Force medical units lost their territorial designations and were 
given consecutive numbers as R.A.M.C. units. The records of 
the Territorial Force R.A.M.C. were transferred from the 
R.A.M.C. T.F. depot units to the office of the regular R.A.M.C. 
records in June, 1917, and the system of regimental numbering 
then became a corps instead of a unit numbering. Recruiting 
ior the R.A.M.C. T.F. units, as individual units, thus ceased, 
and was merged in the general arrangements for recruiting the 
R.A.M.C. as a whole. The numerous R.A.M.C. T.F. depots 
were abandoned at the same time and one central depot formed 
at Blackpool. The sanitary sections, however, continued to 
be recruited through the London Sanitary Companies of the 
Territorial Force, whose headquarters were at the Duke of 
York's School in London. 

Recruiting from the civil medical profession to fill the officer 
ranks of the Army Medical Service presented many difficulties, 
chiefly in connection with the management of civil practices 
and the obligations of civil medical practitioners serving under 
the National Health Insurance Commissioners and other public 
bodies. Reference has already been made to the ready response 
of the civil medical practitioners to accept temporary com- 
missions in the R.A.M.C. on the outbreak of war. But the 
conflicting demands of the civil and military medical services 
soon led to attempts to regulate the flow of medical men from 
civil to military life. The first step in this direction was taken 
fay Dr. Hamilton, of Hawick, as chairman of the Scottish 
Committee of the British Medical Association. He called a 
meeting of its members on the 12th August, 1914, to consider 
arrangements for continuing the civil work and conserving the 
interests of some 300 medical practitioners in Scotland who 
had. mobilized as Territorial Force medical officers on the 
declaration of war. A Scottish Medical Service Emergency Com- 
mittee was then formed, its purpose being to provide medical 
officers for the army with due regard to the needs of the 
civil population and the personal position of individual doctors, 
and to look after their interests during their absence on military 
service.* This was followed by a similar committee being 
formed in London by the metropolitan counties branch of the 
British Medical Association to deal with civil medical work in 
the metropolitan area. The British Medical Association then 
decided to extend to the United Kingdom as a whole 
measures for adjusting the recruiting of medical officers to 

* It was estimated that a sixth of the medical profession in Scotland 
had taken commissions in the R.A.M.C. by February, 1915. 



RECRUITING OF MEDICAL SERVICES 145 

the needs of the civil community, and a committee com- 
posed of the chairman of its standing committees was formed 
for this purpose. Its first meeting was held on the 5th 
February, 1915. 

In March, 1915, the Director-General of the Army Medical 
Service announced that 2,000 medical officers were required for 
the army. This demand caused considerable consternation 
amongst the members of the medical profession generally, and 
led to a committee of reference of the Royal Colleges of Physi- 
cians and Surgeons being formed to consider to what extent 
staffs in teaching schools and hospitals could be reduced in the 
metropolitan area. A Dublin War Emergency Committee was 
also established in May, 1915.* 

In July, 1915, these committees were amalgamated as a War 
Emergency Committee for England, Wales, and Ireland, which 
became known as the " Central Medical War Committee " in 
the following October. The object of this committee, accord- 
ing to its terms of reference, was " to organize the medical 
profession in such a way as to enable the Government to use 
every medical practitioner fit to serve the country in such a 
manner as to turn his qualification to the best possible use " ; 
and " to deal with all matters affecting the medical profession 
arising in connection with the war." Representatives of the 
Scottish and Irish committees were nominated to serve on the 
central committee, which kept in close touch with the 
medical department at the War Office. Local medical war 
committees were also formed throughout the country by 
branches of the British Medical Association. 

When Lord Derby introduced his group scheme of enlistment, 
in November, 1915, he handed over the whole of the recruiting 
for officers of the R.A.M.C. to this Central Medical War Com- 
mittee for England and Wales, to the Scottish War Emergency 
Committee for Scotland, and to the Irish Medical War Com- 
mittee for Ireland. The Central Medical War Committee then 
arranged to enrol the medical practitioners in England and 
Wales in twelve groups, based on varying conditions of local 
civil requirements, security of practices and appointments, age, 
and family obligations. Under this scheme 5,253 medical practi- 
tioners enrolled voluntarily for service if called up. When 
compulsory military service came into force in January, 1916, 
the War Office announced that no medical practitioner under 
45 years of age would be employed as an officer of the 
R.A.M.C. unless he undertook general service, and that 
none over 55 would be accepted for home service. The 

* Afterwards it became the Irish Medical War Committee. 
(1735) L 



146 MEDICAL HISTORY OF THE WAR 

Scottish Medical War Emergency Committee then put forward 
a scheme for recruiting medical officers in three groups : those 
under 45 to be commissioned for general service as 
lieutenants R.A.M.C., those between that age and 55 as 
lieutenants for home service, locum tenens, or part-time military 
and civil work, and those over 55 for part-time work and 
locum tenens work. 

In April, 1916, the War Office officially recognized and relied 
on the Central Medical War Committee and the corresponding 
committees in Scotland and Ireland as professional committees 
for dealing with claims of qualified medical practitioners for 
exemption from military service under the Military Service 
Acts ; and, under the regulations of the Act they were entitled 
to appoint and recognize local professional committees to act 
in a similar capacity. They were eventually recognized as 
tribunals to which medical practitioners might appeal without 
being required to appear before the local tribunals appointed 
by the Local Government Board. 

In December, 1916, the professional committees decided to 
mobilize the whole medical profession for such service as each 
member of it was competent to give ; but some disturbance 
of the relations between the committees and the War Office 
was caused by the latter sending calling-up notices in April, 
1917, to every medical practitioner in the country under 41 years 
of age without reference to the professional committees. 
The Central Medical War Committee protested against this 
action and the Secretary of State for War then agreed 
that, according to the numbers required from time to time 
by the Director-General of the Army Medical Service, the 
professional committees alone should call up medical men for 
service. 

By the first of January, 1917, more than half of the medical 
profession had been called up for military service. There were 
then 12,363 medical officers in the army, the number in civil 
practice being somewhat short of this. 

The recruiting of medical officers for military service thus 
gradually became a conflict of interests between the military 
and civilian requirements, which the professional committees 
endeavoured to adjust. Every effort had been made by the 
military authorities to relieve the situation. Medical students 
who had taken commissions or had enlisted in the ranks while 
in their fourth or fifth year of study were released from military 
service in September, 1915, in order to resume their studies, 
obtain their medical qualifications, and then join the R.A.M.C. 
as commissioned officers. Several qualified men had already 
taken commissions in combatant units of the new armies or 



RECRUITING OF MEDICAL SERVICES 147 

territorial force. In 1917 orders were issued for their transfer 
to the R.A.M.C., an order that was not altogether popular 
with officers who had been serving and fighting with their 
units up till then. The establishments of medical officers in 
field ambulances, general hospitals and other units were cut 
down to a minimum. 

The shortage of qualified medical men of ages suitable for 
commissions in the R.A.M.C., especially of younger men for 
service with regimental and field medical units, however, 
became more and more acute as the war went on. By the 
1st January, 1918, it was estimated that the number left in 
civil practice was only 11,482 as compared with 12,720 in 
military service. The situation was immensely relieved when 
the United States of America declared war against Germany. 
Unofficial correspondence had taken place between the Director- 
General of the Army Medical Service and the Surgeon-General 
of the United States Medical Service, and, as a result, in order 
to act as a liaison between the medical services of the United 
States and the British Army, Colonel T. H. J. C. Goodwin was 
selected to proceed to Washington and place himself in touch 
with Surgeon-General Gorgas, the head of the medical service 
at the War Department there. Colonel Goodwin arrived in 
Washington on the 25th April, 1917, and submitted a scheme 
for the assistance which the United States might give to the 
British as regards medical and nursing personnel. Three days 
later, on the 28th April, after an interview with the War 
Secretary, he obtained sanction for the immediate despatch to 
England of six base hospitals, complete in medical and nursing 
personnel, and 112 additional medical officers, and arranged 
for the despatch at a later date of further contingents of 
medical officers and nurses. Early in May he began a series 
of instructional lectures at the Army Medical School, Washing- 
ton, at the War College, and at other places. He also made 
tours of inspection and gave instructional lectures at 
various camps and cities throughout the United States, as 
well as attending numerous meetings of medical and surgical 
societies. 

The promptness and cordiality with which the United States 
Army authorities met in this way the requests of the British 
in connection with the medical services cannot be too strongly 
emphasized, or too warmly appreciated. It was agreed that 
the medical officers lent to the British Army should be placed 
entirely at the disposal of the British authorities, but that the 
United States Government would continue to pay them at its 
rate of pay and also provide their personal outfit. 

(1735) L 2 



148 



MEDICAL HISTORY OF THE WAR 



The dates of arrival and composition of these general 
hospitals were as follows : 



Date of 
arrival. 


Unit. 


Medical 
Officers. 


Dental 
Surgeons 


Chap- 
lains 


Quarter 
masters. 


Rank 
and File. 


Nurses- 


18/5/17 


No. 4 


22 


3 





1 


156 


69 


23/5/17 


No. 5 


24 


2 


1 


1 


154 


68 


23/5/17 


No. 2 


23 


2 





1 


154 


71 


28/5/17 


No. 21 


24 


2 


1 


1 


150 


65 


28/5/17 


No. 10 


23 


2 


1 


1 


156 


68 


3/6/17 


No. 12 


25 


2 


1 


1 


153 


64 



They landed complete at Liverpool, except No. 12, which dis- 
embarked at Falmouth. The majority of the officers and all 
the nurses were at once brought to London, and lodged in the 
Curzon Hotel as the guests of the British Government. The 
rank and file accompanied by a few officers were sent to the 
Royal Army Medical Corps Training Establishment at Black- 
pool, pending their departure for France. 

In the meantime, arrangements had been made for a con- 
ducting party of officers and other ranks from each British unit 
in France, designated to receive them, to come over and conduct 
them to France. The units then embarked for France as 
follows : 



Name of Unit. 


To France 
on 


Posted to 


Location. 


No. 4 Unit 


24/5/17 


No. 9 General Hospital 


Rouen. 


No. 5 Unit* 


30/5/17 


No. 1 1 General Hospital 


Dannes Camiers. 


No. 2 Unit 


30/5/17 


No. 1 General Hospital 


Etretat. 


No. 21 Unit 


9/6/17 


No. 12 General Hospital 


Rouen. 


No. 10 Unit 


9/6/17 


No. 10 General Hospital 


Treport. 


No. 12 Unit 


11/6/17 


No. 18 General Hospital 


Dannes Camiers 



* This unit was later transferred to No. 13 General Hospital at Boulogne. 

In course of time, after the American personnel had become 
familiar with the administration of the British services, the 
British personnel was gradually withdrawn, and the U.S.A. 
officers assumed entire control, the registrar and quartermaster 
being then the only British officers left with the general 
hospitals to which the American units had been posted. The 
commanding officer and adjutant of each unit were regular 
officers of the United States Medical Corps. The remaining 
officers were members of the Medical Reserve Corps, United 
States Army. 

The American units were found at first to be deficient in 
subordinate personnel as compared with the British establish- 
ments, but drafts arrived later, so that it was possible to relieve 



RECRUITING OF MEDICAL SERVICES 149 

nearly all of the Royal Army Medical Corps men employed in 
the general hospitals to which the American units were posted. 
These American base hospital units were composed of 
officers selected from some of the best known medical schools 
in the United States, each school contributing the personnel 
of one unit. Thus : 

No. 4 Unit came from Cleveland University. 

No. 5 Unit Harvard University. 

No. 2 Unit ,, Presbyterian Medical School. 

No. 21 Unit St. Louis University. 

No. 10 Unit Philadelphia University. 

No. 12 Unit Chicago University, 

and it was decided that each British general hospital should 
bear the name of the medical school of the American unit 
posted to it, while retaining its number as a British unit, thus 
No. 9 General Hospital was known as No. 9 (Cleveland 
U.S.A.) General Hospital, and so on. They continued to act 
as British general hospitals until early in 1919, when they 
were gradually withdrawn to the United States. 

In addition to the medical units, a party of 20 orthopaedic 
surgeons arrived at Liverpool on the 28th May, 1917, under 
the charge of Major G. W. Ewing. After a short stay at the 
Curzon Hotel as the guests of the British Government, they 
were posted to the various orthopaedic hospitals throughout 
the United Kingdom. 

Major W. J. L. Lyster, of the regular United States Medical 
Corps, was attached to the medical directorate at the War 
Office for the purpose of acting as liaison officer. He was 
succeeded by Colonel M. A. De Laney, who was replaced later 
by Colonel A. M. Whaley. The latter officer continued to 
carry out the duties until June, 1919, when he returned to the 
United States of America. 

Parties of officers of the Medical Reserve Corps, U.S.A., also 
began to arrive in England in May, 1917, and continued to do 
so until November, 1918. They were drafted to regimental and 
field medical units of the British Army. As the American army 
in France began to be organized many of the American medical 
officers were withdrawn from duty with the British service and 
re-posted to the American army for duty. They were replaced 
by new arrivals from America, and after a few months spent in 
the hospitals in the United Kingdom they were transferred to 
France and Italy. They were not sent to other theatres of war. 
Early in 1919 these officers were gradually withdrawn, until by 
June, 1919, none remained, but during the critical years of 1917 
and 1918 the total number of officers lent to the British Forces 



150 MEDICAL HISTORY OF THE WAR 

remained at a high figure and thus contributed in a large measure 
to the maintenance of the Royal Army Medical Corps services 
which were so severely tried during those years. The number of 
U.S.A. medical officers attached to British units other than 
base hospitals was 1,253. The U.S.A. personnel in base hospital 
units was 174 officers, 1,174 enlisted other ranks, and 735 nurses. 

In addition to those attached to the base units, two large 
contingents of nurses consisting of about 100 each arrived 
from America on the 16th February and 1st June, 1918. The 
first party proceeded to France after a short stay in London 
and was distributed among the various British hospitals. The 
second party was accommodated at the Berners Hotel for 
about a week, and then was distributed to various hospitals 
throughout the United Kingdom. The members of it remained 
in England for several weeks doing duty with the Queen 
Alexandra's Imperial Military Nursing Service, but eventually 
they were all transferred to France. 

But, notwithstanding these invaluable reinforcements, owing 
to the great and unforeseen casualties in the commissioned 
ranks of the R.A.M.C. and other causes the demands on the 
civil profession continued and threatened to drain the country 
of civil medical practitioners. Various public bodies were 
affected as well as established general and consulting practices. 
The National Insurance Commisssioners, the Local Government 
Board, the Board of Control, the medical schools, and large 
civil hospitals had claims on many of those who were liable to 
be called up for military service ; and the Royal Navy and 
Air Force had also to be provided with medical officers. The 
task of the professional committees and of the Director-General 
of the Army Medical Service was far from easy or simple, and 
the calling up of medical men and their distribution in the army 
were bound to produce discontent in many quarters. Some of 
those who had taken contract commissions for one year returned 
to civil life with tales of having had little to do or being given 
work for which they were not fitted, or of not being given work 
for which they were specially qualified. It was not realized 
that, in its very essence, war meant for the medical services 
periods of overwhelming strain and strenuous effort, with 
periods of comparative rest and idleness ; and that specializa- 
tion in medical work was not feasible, at any rate in the areas 
of active fighting. But whatever may have been the true 
causes there was a widespread feeling amongst the medical 
profession at home and the general public that greater economies 
could be effected by the Director-General, and that the distri- 
bution of medical duties both at home and in the field was at 
fault. The matter was brought to a head at the beginning of 



RECRUITING OF MEDICAL SERVICES 151 

August, 1917, by the Central Medical War Committee inform- 
ing the Secretary of State for War that, after a careful survey of 
the whole of England and Wales, they were of opinion that no 
more medical men could be called upon to take commissions 
in the R.A.M.C. without seriously endangering the supply of 
doctors for the treatment of the civil community, and that 
further depletion could only be effected on the responsibility 
of the Government after carefully comparing the military with 
the civil needs. This letter followed a letter from the Adjutant- 
General in France of 24th July, 1917, pointing out that there 
was a shortage of 328 medical officers at the beginning of the 
month, and that, to prevent a breakdown in the medical services 
in France, the despatch of reinforcements suitable for duty 
with the field armies was urgently required. A committee 
was consequently appointed by the Secretary of State for War 
on the 22nd August, 1917, to proceed at once to France for the 
purpose of enquiring into various matters connected with the 
personnel and administration of the Army Medical Services in 
that country, and on their return they were to carry out similar 
investigation in the United Kingdom.* 

The committee went to France on the 1st September, 
returned to England on the 27th September, and submitted 
their report on the 20th December, 1917.f They were unable, 
however, to suggest measures practically possible for effecting 
economies, or for a better distribution of medical officers, which 
had not already been carried out or were in process of being 
carried out. 

A similar investigation was not made in the United Kingdom 
by this committee, but when Sir John Goodwin became Director- 
General in 1918 a committee was specially appointed to consider 
the staffing of medical establishments in the United Kingdom 
in its relation to the numbers employed and their distribution.]: 
They held ten meetings and made several recommendations, 
most of which were already in process of being carried out 
where practicable. But the committee attacked chiefly the 
system of staffing the territorial force general hospitals with 
a la suite officers of high local standing ; and this adverse 
criticism was still further emphasized by the Ministry of National 

* Major-General Sir Francis Howard was appointed chairman, and other 
members were Sir F. Taylor, President of the Royal College of Physicians ; 
Sir Rickman Godlee, President of the Royal College of Surgeons ; Sir W. 
Watson Cheyne, M.P. ; Lieut.-Colonel H. J. Stiles, F.R.C.S. ; Dr. Charles Buttar 
(Central Medical War Committee) ; Dr. Norman Walker (Scottish Medical 
War Emergency Committee) ; with Dr. J. Christopherson as secretary. 

f The report was not published. 

J The Committee was constituted of Sir Berkeley Moynihan (Chairman), 
Sir Harold Stiles, Colonel Carless, Sir Gilbert Barling, and Sir James Galloway. 



152 MEDICAL HISTORY OF THE WAR 

Service in a letter to the Secretary of State for War of the 
1st August, 1918, in which it was stated that the a la suite system 
was an extravagant one from the point of view of medical 
administration. It was thought that the work of a territorial 
force general hospital could be performed more satisfactorily 
by a smaller staff of whole-time officers, and that a number of 
the a la suite officers might be made available for service in 
the R.A.M.C. overseas or as whole-time officers elsewhere. But 
the chief objection to the system appears to have been that it 
placed these officers in a position of unfair advantage over their 
colleagues in the profession, because they held a commission 
and, although doing in many instances very little military work, 
were in full enjoyment of their private practice and of army 
pay. Their position was, in fact, causing much feeling of dis- 
contentment in the profession both in and out of the army. 

The original conception of the staffs of territorial force 
general hospitals on an a la suite basis had proved faulty at 
the very commencement of the war. It left out of considera- 
tion the requirements of pathological and clinical laboratories, 
radiology, anaesthetics, and the other specialized work of large 
hospitals, as well as the need of junior medical officers for 
orderly medical duties. These had consequently to be appointed 
early in the war, immediately after the general hospitals 
had opened for work. The system proved progressively un- 
satisfactory as the war went on. The a la suite officers, in 
fact, were part-time officers only, and had to devote much of 
their time to the work of large civil hospitals and medical 
schools as well as to their consulting practice. 

The committee's report and the letter from the Ministry of 
National Service were considered by the Army Medical Advisory 
Board at the end of August, 1918. They recommended that 
the system should be maintained, but that a minimum of three 
hours* on duty daily within the hospital should be enforced 
on all a la suite officers, and that any officers surplus to re- 
quirements by this increased attendance should be demobilized. 
No further action, however, was necessary, as hostilities showed 
signs by this time of coming to an end and the demand for 
additional medical officers for the army had practically ceased. 

When recruiting for the army generally was removed from the 
War Office in November, 1917, the Ministry of National Service 
became the intermediary between the Central Professional 
Committees and the Admiralty, the War Office, and the Air 
Force, and became responsible at the same time for the main- 
tenance of adequate medical services for the civil population. 

* In many instances the average daily attendance had been less than 
one hour. 



RECRUITING OF MEDICAL SERVICES 



153 



The Ministry of National Service, however, continued the 
policy of not calling up for service or sanctioning a commission 
being granted to a civil medical practitioner without refer- 
ence to the professional committee concerned. When demobi- 
lization of the medical services commenced, the return of medi- 
cal officers to their civil practices was carried out through the 
same channels until the end of March, 1919, when they abruptly 
ceased to function on the immediate demobilization of 2,000 
medical officers being ordered by the Secretary of State for War. 

With regard to other ranks of the R.A.M.C., the total 
number enlisted between the 4th August, 1914, and the llth 
November, 1918, was 154,374, of whom 48,429 were raised for 
the Territorial Force R.A.M.C. 

The growth in the numbers of officers and men is shown in 
the following table of those on the effective strength of the 
R.A.M.C. in August of each year up to the time of the Armistice. 





Officers. 


Other ranks. 


Date. 


Regular 


Territorial 


Regular 


Territorial 




Forces. 


Force. 


Forces. 


Force. 


August, 1914 


1,279 


1,889 


3,811 


12,520 


1915 


6,230 


2,300 


49,525 


? 


1916 


9,000 


3,300 


71,276 


40,500 


1917 


10,370 


3,130 


93,359 


33,000 


1918 


10,178 


2,885 


100,176 


30,923 


Nov. 1918 


10,190 


2,845 


98,986 


32,375 



The figures in the first column for officers include 150 
dental surgeons in August, 1915, 300 in 1916, 501 in 1917, 
714 in August, 1918, and 831 in November, 1918.* 

The large number of recruits who enlisted in the R.A.M.C. 
at the beginning of the war, and the mobilization and training 
of medical units for the divisions of the new armies called for 
great expansion of depot accommodation and the establishment 
of several new training centres. Previous to the war there 
had been only one depot where young officers and men of the 
R.A.M.C. were received and trained. It was at Aldershot, had 
accommodation for 800 only, and consisted of three depot 
companies and a training establishment. One additional com- 
pany was formed in August, six more in September 1914, 
and, in the latter month, a provisional company for personnel 
of the R.A.M.C. returning to England from stations abroad 

* The number of dental surgeons increased after the Armistice, 849 being 
shown on the effective strength in January, 1919, 842 in February, 1919, and 
832 in March, 1919. The numbers then gradually declined to 378 in October 
of that year. 



154 MEDICAL HISTORY OF THE WAR 

and from the expeditionary force was also formed. The depot 
at Aldershot was at first expanded by accommodating 3,000 men 
in a camp at Redan Hill and some 2,000 more in another 
camp in Stanhope Lines. They were put into billets in Decem- 
ber, 1914, but were later moved into various married quarters 
and huts in Tweseldown Camp, near Aldershot. In September 
and October, 1914, the new depot companies became training 
centres and were transferred to Tweseldown Camp* and to 
Llandrindod Wells. Additional training centres for the R.A.M.C. 
of the new armies were formed at Limerick, Sheffield, East- 
bourne, and Tidworth Park on Salisbury Plain. Later on, in 
1915, Prestatyn became a training centre for the R.A.M.C. of 
the Welsh Division, and Ripon was also opened as a R.A.M.C. 
training centre. The Tidworth Park training centre was trans- 
ferred to Torquay during the winter of 1914-15, and returned 
to Salisbury Plain in April, 1915, when it was established at 
Codford. Other considerable changes were also made, the 
Limerick centre moving to Dundalk and again to Birr, while 
the Llandrindod Wells centre moved to Sling, and both were 
eventually embodied in the Codford centre. 

Until 1917 medical units continued to be trained at all these 
centres. New units were mobilized there and drafts and 
reinforcements sent from them overseas. The amount of work 
done in them may be estimated from the fact that they 
trained and sent overseas the personnel of 94 field ambulances, 
5 casualty clearing stations, 6 stationary and 10 general hospitals, 
7 motor ambulance convoys, 4 hospital ships, and 20,198 in 
reinforcement drafts, in addition to men transferred to the 
Aldershot depot for the drafts which were being formed 
there. 

The instructional staff for the new training centres was 
obtained by withdrawing officers and non-commissioned officers 
of the regular R.A.M.C. from the R.A.M.C. Territorial Force 
schools of instruction which were permanent institutions in time 
of peace. Each of the new centres held from 1,500 to 4,000 
recruits, and 2 or 3 regular R.A.M.C. officers and 6 to 8 non- 
commissioned officers were allotted to each.f The training 
consisted of the usual training in military duties, drill, and 
stretcher-bearer work. Each training centre was sufficiently 
large to require a camp hospital of its own, and the men were 
attached to .it in batches for training in hospital duties, 
although it was recognized that this was inadequate and 

* Also known as Crookham Training Centre. 

f The accommodation was as follows : Tweseldown 3,000 in huts ; 
Eastbourne 1,000 in tents and huts; Tidworth 3,000 in tents; Sheffield 
1,400 in barracks ; Llandrindod Wells, 4,000 in billets. 



TRAINING OF MEDICAL SERVICES 155 

could only be regarded as a preliminary introduction to their 
training in nursing duties. 

The general training carried out in this way at the beginning 
of the war was necessarily of s.hort duration, as recruits had to 
be allotted rapidly to the field medical units of the first four 
new armies, but in order to remedy this state of affairs, instruc- 
tions were issued in February, 1915, for as many young R.A.M.C. 
recruits as possible being sent in drafts to the various commands 
for a course of instruction in hospital work. They were to re- 
place there the men with greater experience, who were then to 
be withdrawn from time to time to complete the mobilization 
of new medical units. In a later instruction of the same month 
the personnel of the R.A.M.C. under training for field ambulances 
of new army divisions were to remain at their training centres 
until mobilization was ordered and were not to come under 
the orders of the division until then. Later on in 1915 it was 
found impossible to assemble these field ambulances as complete 
units until very shortly before their embarkation, and in Sep- 
tember of that year the whole of the horse transport, including 
vehicles, harness, and transport equipment, mobilized separately 
under the officer commanding the divisional train and was 
trained as a complete unit from a transport point of view under 
him. It was not handed over to the officer commanding the 
field ambulance concerned until then. 

The territorial force medical units were trained separately 
at their territorial force depots. Second line field ambulances 
were raised as complete units to replace those which had gone 
overseas with their divisions. They were to be prepared at all 
times to furnish the best men possible to replace wastage in 
their first line units, and in turn to have their places filled by 
men from third line field ambulances, also in process of being 
formed.* In March, 1915, the functions of the second and third 
line medical units of the territorial force divisions were more 
clearly stated. The normal organization was then defined as 
being in two lines with a third line depot behind them. All 
recruits were to be sent in the first instance to the third line ; 
and no man was to be transferred from it until he had completed 
his recruit's course of training. The third line depot thus became 
the depot in which the Territorial Force R.A.M.C. were trained 
and from which drafts were provided both for the first and 
second line medical units. The depot was normally to be the 
peace headquarters of the unit. The second line units were to 
be ready to take the place of the first line units when required, 

* The first line units had been making a convenience of the second line units 
by sending to the latter men unfit for service. This practice was stopped 
when the above instructions were issued in February, 1915. 



156 MEDICAL HISTORY OF THE WAR 

and were only to be called upon to provide drafts for the first 
line when absolutely necessary ; and this duty of providing 
drafts was to cease altogether when the third line depots were 
in a position to carry out their allotted functions. The neces- 
sary instructional staff for the depots was to be furnished by 
the second line units. 

The whole system of training the R.A.M.C. was changed 
towards the end of 1916 and beginning of 1917, when the Alder- 
shot depot and the various training centres were transferred 
to Blackpool and concentrated there under an administrative 
headquarters. At first each of the old centres retained its 
individuality at Blackpool, with its own instructional staff and 
organization ; each also maintained a depot for mobilizing new 
units and providing reinforcement drafts. The men were 
placed in billets and trained on the sea-shore or promenade of 
Blackpool. But this organization was broken up in July, 1917. 
One large training centre with a separate depot was then 
formed under the command of a surgeon-general.* 

The original organization had produced good results, but it 
was considered that greater economy in personnel could be 
effected ; that the multiplication of classes for officers and 
N.C.O.'s was responsible for a considerable wastage of instruc- 
tion ; that there was a lack of uniformity in the training carried 
out by the various centres, and that the mixing of recruits under 
training with the mobilization of new medical units and the 
formation of reinforcing drafts was a serious hindrance to 
efficient and speedy recruit training. Also there was no fixed 
establishment of officers and N.C.O.'s. 

The training centres, as distinct from the depot, were accord- 
ingly organized on a divisional basis of two brigades of four 
battalions each, and included an officers' school of instruction. 
Each battalion consisted of 1,000 recruits. The depot was 
organized in five depot companies, a reserve battalion of three 
provisional companies, with 600 men in each company, and 
two territorial force companies ; but it also included a 
non-commissioned officers' training company, a school of 
instruction for cooks, clerks, X-ray, laboratory and mental 
attendants, a school of sanitation, an anti-gas school of three 
sections, and a R.A.M.C. command depot.f In March, 1918, it 

* Surgeon-General A. A. Button. He was in command of the depot at Alder- 
shot at the beginning of the war. He went to Salonika in November, 1915, q<? 
D.D.M.S. Lines of Communication, and was recalled from that post to take 
up this duty at Blackpool with the rank of surgeon-general. 

t The command depot for R.A.M.C. was transferred in July 1917 to 
Ballykinlar and relieved the depot of a large number of men who were not 
yet fit for drafts. The duties of a command depot at Blackpool had previously 
been carried out by the provisional companies. 





CHART OF MOVEMENT OF R.A.M.C. RECRUITS 




PREVIOUS TO BEING DRAFTED AS REINFORCEMENTS 


FOR THEATRES OF WAR 






BECOMING AVAILABLE FOR OVERSEAS: 




























5 










1 


rf s i= IFINAL LEAVE. ANTI-GAS TRAINING. 

2 COMPLETION OFOOCUMENTS.EQUIPMENT 
US'- JAN'D PREPARATION FOR OVERSEAS: 


























7 










t / 


























/ 










/ 






FROM 


HOME HOSPITALS TO DEPOT: 

































% 








HOSPITAL 
COURSE 


TRAINING AT 
HOME 
HOSPITALS 




















/ 










/ 


























o 


/ 








/ 


























1 


^1 








r( 





























k 


'/ 






/ 


<^. 




























^1 






/< 


^ 






























'/ 




A 


\ 






























V- j 


f 


/ 


<j> 
































/: 


/ 




































y 


























FROM TRAINING BATTALIONS TO HOME HOSPITALS: 












O 




























RECRUITS 
COURSE 


ELEMENTARY INSTRUCTION 
R.A.M.C. TRAINING 
INCLUDING FIRST AID ETC: 










f 




































^ 




































/ 




































/ 




































RECRUITSJANDTRANSFERS] TO TRAINING BATTALIONS 


O 








































1 WEEKS 


1 


2 


3 


4 


5 


6 


7 


8 


9 


10 


II 


12 


13 


14 


IS 


16 


17 


18 


19 





S5789/+-'F..IOOa. l.tl 



TRAINING OF MEDICAL SERVICES 157 

was renamed' the R.A.M.C. Reserve Depot with an authorized 
establishment consisting of a headquarters, five regular 
companies, one reserve battalion of three provisional companies, 
two T.F. companies, 1st and 2nd London sanitary companies, 
and an anti-gas school of three sections. Specially selected 
officers of the R.A.M.C. and an adequate instructional 
staff formed part of the battalion establishment for the 
supervision of the technical training of the recruits and 
their instruction in R.A.M.C. duties. The training centre 
as a whole was under the command of a senior officer of the 
R.A.M.C., with headquarters staff, who controlled the two 
brigades. The functions of the training battalions were to 
receive all recruits and transfers from other arms in rotation 
of battalions, and have all medical inspection, inoculation, 
vaccination, and dental, aural and ophthalmic treatment 
carried out when necessary. The recruits were classified 
according to their physical fitness for different duties and dis- 
tinguished by differently coloured badges. Their training 
lasted four weeks as a minimum, and they were then drafted 
to home hospitals for instruction in ward duties. They 
returned then to the R.A.M.C. depot, as required, to form new 
units or reinforcements. 

In August 1917, owing to the shortage of medical officers, 
infantry officers unfit for service overseas, gradually replaced 
R.A.M.C. officers in command of the depot companies, with 
the exception of the provisional companies, for company 
duties, and for instructing in anti-gas measures. This exchange 
of officers proved successful. Combatant officers carried out 
their duties, with enthusiasm and loyalty to the R.A.M.C. to 
which they were attached. 

No recruits were received into the depot companies, which 
thus consisted entirely of fully trained N.C.O.'s and men, from 
amongst whom all drafts were found and new medical units 
mobilized. The reserve battalion received overseas men who 
had returned to England sick, wounded, or from other causes and 
who had been sent to the depot as fit for duty. All men posted 
to the R.A.M.C. as specialists remained only a week or ten days 
in the training battalions for vaccination, classification, clothing, 
and a short modified course of drill. They were then trans- 
ferred to the depot for instruction in the specialist schools 
there, pending their being drafted for specialist work overseas 
or in home hospitals. Every officer and man went through 
a course of anti-gas instruction at the depot before proceeding 
overseas, and this formed part of his final preparation before 
embarkation. 

The recruiting and training of the Territorial Force R.A.M.C. 



158 MEDICAL HISTORY OF THE WAR 

were also brought into line with the training centre and depot 
at Blackpool in 1917. In November of the preceding year the 
third-line mounted brigade field ambulances were disbanded and 
their ranks posted to the regular R.A.M.C. training centres ; and 
in February, 1917, nine second-line and two third-line territorial 
force field ambulances were also disbanded in consequence of 
the formation of home service field ambulances. This was fol- 
lowed in March, 1917, by the abolition of all third-line R.A.M.C. 
units and depots of the territorial force, and transferring them 
as territorial force training companies of the R.A.M.C. training 
centres at Blackpool ; with the exception of the London sani- 
tary companies, which continued to receive recruits at the Duke 
of York's school in London until July, 1918, when they were 
also transferred to Blackpool. But when the reorganization 
of the Blackpool training centres was carried out in July, 1917, 
by Surgeon-General Sutton, and as no recruits were being 
posted to T.F. units, the T.F. training companies then 
became depot companies of the R.A.M.C. depot and provided 
the reinforcement drafts for the T.F. medical units overseas. 
The various depots and training centres for R.A.M.C. T.F. 
were thus merged in the one training centre and depot of the 
R.A.M.C. at Blackpool. 

This new organization proved most effective and continued 
till the end of the war, when the training centre was demobi- 
lized and the depot returned to Aldershot in March, 1919, 
moving in the following September to new permanent quarters 
in hutments at Tweseldown Camp. The reserve battalion, 
however, remained at Blackpool as the demobilization centre 
and clearing unit for R.A.M.C. returning from the expeditionary 
forces. It consisted then of about 6,000 men, some of whom 
were not eligible for demobilization and were sent to the depot 
or direct to home hospitals.* By October, 1919, the numbers 
in it had decreased to that of an ordinary company, and it then 
rejoined the depot at Tweseldown as a provisional company 
there. The London sanitary companies also remained at 
Blackpool in order to take advantage of the school of hygiene 
established there. 

The work of the R.A.M.C. depot from October, 1914, to June, 
1918, included the despatch of 29,604 reinforcements to all 
theatres of war and the mobilization of personnel for 47 general 
hospitals, 26 stationary hospitals, 42 casualty clearing stations, 
32 ambulance trains, 38 motor ambulance convoys, 51 hospital 

* The number demobilized up to the end of 1919 through the reserve 
battalion was 10,948. 35,000 men had passed through the provisional 
company or reserve battalion since its formation. 



ORGANIZATION OF THE 

R . A. M C . RESERVE TRAINING CENTRE 
BLACKPOOL. 



SURGEON GENERAL 

D.A.A.G 

DO.MS 

i OFFICER R A. MC. (SANITARY) 

I OFFICER RA.M.C (SPECIAL DUTIES) 
29 OTHER 



80FFICF.R3 R.A.MC 
3.0FFICERS COMBATANT 
391 OTHER RANKS * 





7.0FFICERS R.AM.C. 
4 OFFICERS COMBATANT 
577.OTHER RANKS 



3 COMBATANT OFFICERS 
AND 25 OTHER RANKS IN 
EACH COMPANY. 



* OF Fl CCHS.. 

RA.M.C. 
4 OFFICERS 

COMBAT AN 
4* OTHER 

RANKS 



3 OfflCEfiS 
COMBATANT 
4C OTHER RANKS 




2 COMBATANT OFFICERS AND 21 
OTHER RANKS Ifcl E ACK BATTALION 
HEADQUARTERS. 
(COMBATANT OFFICER AND IO 
OTHER RANKS IN EACH COMPANY. 
WITH 220 IN EACH COMPANY 
ATTACHED FOR TRAINING 



3OFFICERS RA.M.C. 
2LOFFICERS COMBATANT 
93.OTHER RANKS. 
ISO.R.A.M.C OFFICERS 
ATTACHED FOR 

TRAINING 



I COMBATANT 

OFFICER AND 

II OTHER RANKS 
IN EACH COMPANY 



364 TRAINED MEN 

ON"EMPLOYMENTS" 



TOTAL. 
IN TRAINING CENTRE 

23 OFFICERS R.A.M.C. 
87 CQMBATANT 

1837 OTHER RANKS. 



ISO R.A.MC OFFICERS AND 
7O4O OTHER RANKS. 
ATTACHED FOR TRAINING. 



540 TRAINED MEN 

ON"EMPLOYMENTS" 



TRAINING OF MEDICAL SERVICES 159 

ships, several field ambulances and cavalry field ambulances, 
12 advanced and 12 base depots of medical stores ; exclusive 
of reinforcements and units, mentioned above, which were 
mobilized from the training centres previous to the concen- 
tration at Blackpool. A number of officers of the Medical 
Reserve Corps of the United States Army also went through 
a course at the Blackpool R.A.M.C. depot. 



CHAPTER IX 

THE SUPPLY OF MEDICAL AND SURGICAL EQUIPMENT 
AND STORES 

MEDICAL and surgical supplies are to the Army Medical 
Service what ammunition is to the fighting forces. The 
task of providing medical and surgical equipment and stores was 
consequently a task of the highest importance, and second to 
none other during the war, so far as the care of the sick and 
wounded was concerned. Without a constant and sufficient 
supply at all tunes and in all places the personnel of the 
medical services would have been powerless. The branch 
of the directorate of medical services at the War Office, 
of which Colonel G. B. Stanistreet had charge until the 
beginning of 1918 and Colonel J. R. McMunn after him, was 
responsible for the organization, provision and maintenance of 
this service. From its very nature it was a highly centralized 
service, as otherwise wastage, overlapping and loss of control, 
with their resulting confusion and lack of economy, could not 
have been avoided. Careful and valuable records were main- 
tained by the branch, and it has been possible from these to 
give an account of the immense work done by it and the great 
responsibilities of its task under conditions of exceptional 
difficulty. 

On the 4th August, 1914, field medical equipment and 
medical stores were ready for issue to the regimental and 
medical units of the original expeditionary force ; the regi- 
mental and field medical units of the Territorial Force were in 
possession of their peace scale of field medical equipment, 
and the additional equipment required to bring them up 
to war scale was ready for issue ; the military hospitals 
had their usual stock of medical and surgical stores to meet 
peace requirements ; there was a small reserve of field medical 
equipment and other medical stores, such as medicine chests 
and general fracture boxes, in the Army Medical Stores 
at Woolwich ; and the contractors for medical and surgical 
stores were in possession of their customary stocks for meeting 
peace requirements. There were also two subsidiary medical 
stores, one at Southampton for medical and surgical supplies 
to transports, and the other at Dublin for the Irish Command. 

160 



MEDICAL AND SURGICAL EQUIPMENT 161 

On the outbreak of war, contractors were at once warned 
to make arrangements to meet very large demands for medical 
and surgical stores,* all the available field medical equipment 
was secured from the trade and withdrawn from hospitals, and 
special arrangements were made for the supply of vaccines and 
sera for the prevention and treatment of disease, including very 
large quantities of anti-typhoid vaccine, tetanus anti-toxin, 
anti-sepsis vaccine, and cholera vaccine. Large reserves of 
surgical dressings were obtained and despatched to France very 
shortly after the departure of the expeditionary force. 

In order to avoid shortage of medical stores, steps were 
taken by a Royal Proclamation dated the 3rd August, 1914, 
to prohibit the exportation of surgical dressings. A list of 
the estimated requirements of drugs for the army for a period 
of twelve months was drawn up, and after consultation with the 
directors of the leading wholesale drug firms a further Royal 
Proclamation, dated the 10th August, 1914, prohibited the 
exportation of those drugs of which there was likely to be 
a shortage. The matter continued to be considered from time 
to time in consultation with the Contracts Branch of the War 
Office and the National Health Insurance Commissioners with 
a view to safeguarding the needs not only of the army but 
also of the civil population. Various Royal Proclamations and 
Orders of Council were subsequently issued, as the war pro- 
gressed, and further additions were made to the list of drugs 
and surgical dressings, surgical instruments, X-ray apparatus 
and other articles, raw and manufactured, the exportation of 
which was prohibited. 

The staff of the Medical Supplies Branch of the War Office 
on the outbreak of war and the additions made to it during the 
progress of the war have already been noted. It had been 
gradually increased from one R.A.M.C. officer, an Inspector 
and Assistant Inspector of Medical Supplies and three clerks, 
to a total during 1918 of 6 officers, 22 technical assis- 
tants, and 82 clerks, including 49 ladies.f Four specialist 
officers also gave part-time assistance in inspecting surgical 
instruments and appliances and X-ray apparatus. The 
Medical Supplies Branch was completely reorganized and 
divided into sections for dealing with the various supplies, such 
as field medical equipment, drugs, including tablets, surgical 

* On the 13th of August the Director-General gave instructions to his 
medical and surgical supplies branch to maintain dressings for 100,000 wounds 
in the Army Medical Stores. The market was then rapidly becoming exhausted 
owing to the purchases made on behalf of private hospitals. 

f At the end of 1917 the numbers were : 4 officers, 21 technical assistants, 
and 51 clerks, including 37 ladies. In 1919 the numbers were: 5 officers, 
18 technical assistants, and 74 clerks, including 40 ladies. 

(1735) M 



162 MEDICAL HISTORY OF THE WAR 

dressings of all kinds, surgical instruments and sterilizers, 
operating room furniture, cylinders of oxygen and nitrous 
oxide, medical and surgical appliances, including rubber goods, 
splints, electro-medical and mechano-therapeutic outfits, 
vaccines and sera, pathological and bacteriological outfits, X-ray 
outfits, dental outfits, spectacles, home indents, overseas in- 
dents, shipping of stores, contracts, returns, accounts, registers, 
and other matters.* 

The storage accommodation (21,495 square feet) of the Army 
Medical Stores at Woolwich, which were originally established 
chiefly for the supply, packing, and storage of mobilization 
medical equipment for the expeditionary force, was trebled 
during the first year of the war by the erection of 16 sheds, 
which afforded an additional 34,925 square feet of storage 
space, and by the hire of the Plumstead skating rink (9,720 
square feet), close to Woolwich Arsenal railway station, and 
another small store. The staff, which on the outbreak of war 
consisted of a quartermaster and 22 non-commissioned officers 
and men, was increased to two quartermasters and 1 10 subordi- 
nates of both sexes, most of whom were civih'ans.f 

In consequence of the great difficulty of obtaining in reason- 
able time medical and surgical stores in the vastly increased 
quantities necessitated by the extension of active operations 
in the field, it was found necessary after the first year of the 
war to increase the storage accommodation at Woolwich still 
further. A Reserve Medical Store was consequently estab- 
lished, at first in temporary premises at a disused depot of the 
Plumstead tramways, which was taken over on the llth 
October, 1915, and afforded 20,814, square feet of storage 
accommodation. Subsequently, during the first half of 1916, 
nine large sheds with 38,250 square feet of floor space were 
erected on Woolwich Common close to the existing Army 
Medical Store. The tramway depot was still retained for 
the storage of surgical dressings, and the two premises afforded 
59,000 square feet of storage accommodation. Later on, this 
was increased by the opening of two branch stores, which 
brought the total storage accommodation at the time of the 
Armistice up to 99,000 square feet. The staff of the reserve 
store and its branches consisted of three quartermasters and 
125 subordinates, chiefly civilians, both men and women. J 

* Mr. J. B. Barnes was the inspector of medical supplies and Mr. W. H. 
Walden the assistant inspector during this period of ever-increasing work, 

f See Appendix E, Table I. 

j The organization and the expansion of the medical stores at Woolwich 
were carried out by Lt. and Q.M. J. Ritchie and Lt. and Q.M. W. E. Squire, 
R.A.M.C. 



MEDICAL AND SURGICAL EQUIPMENT 163 

The value of the stores held in reserve in the Army Medical 
Stores at Woolwich, which was about 100,000 prior to the 
war, was estimated to be about 1,000,000 by the end of 1917. 
The stores were organized to maintain a reserve estimated to 
last from three to six months, according to the rapidity with 
which the stock of the various articles could be replenished.* 

The position of the reserve was reviewed monthly in the case 
of articles of which a three months' reserve was held and 
quarterly in the case of articles of which a six months' reserve 
was maintained. In the case of the former, on the 1st of each 
month a statement was prepared of the issues made during 
the preceding month, the quantities issued were multiplied by 
three, and if the stock thus computed was not available in 
store, indents were submitted to the War Office for the balance 
required to make up a three months' reserve. Similarly, in the 
case of articles of which a six months' reserve was maintained, 
on the 1st day of each quarter a statement was prepared of 
the issues made during the preceding three months, the quanti- 
ties issued were multiplied by two, and indents submitted to 
the War Office for the balance required to make up a six months' 
reserve. 

By these means the quantities of the various articles held 
in reserve underwent frequent revision and turn over, and 
varied at monthly or quarterly intervals according to recent 
demands, so that undue accumulation of stores for which the 
demand had fallen off was avoided. With the same object in 
view, the officer in charge of each store submitted to the War 
Office on the 7th of each month a list of stores .for which there 
had been little or no demand during the previous month, in 
order that indents for such articles might be passed to him 
direct for supply instead of being sent to the contractor. 

In addition to the two large stores at Woolwich and the 
medical stores at Dublin and Southampton, depots of medical 
stores were opened at one time or another during the first 
three years of the war at Bristol, Liverpool, Reading, North- 
ampton, Edinburgh, York, Cosham, Aldershot, and Dover.f 
The depots at Bristol and Liverpool were originally organized 
as base depots of medical stores for the Central Force, and those 
at Reading and Northampton as advanced depots to be supplied 
by them in the event of operations in the United Kingdom. 
An additional store was opened at Golborne in September, 
1918, for surgical dressings, and stores were established early in 

* A list of the principal articles thus held in reserve is given in Table II, 
Appendix E. 

f The staffs and storage accommodation of these depots are given in 
Table I, Appendix E. 

(1735) M 2 



164 MEDICAL HISTORY OF THE WAR 

1919 at South wick in Surrey and at Ramsgate for the reception 
of stores and equipment from demobilized units pending dis- 
posal. Arrangements were made to obtain medical and surgical 
supplies for the hospitals and troops in Scotland from Scottish 
firms, in the same way as the supplies in Ireland were being 
obtained before the war from Irish firms. 

The general system adopted for complying with indents 
received at the War Office from medical store depots and 
hospitals was as follows : The indent was passed to the con- 
tractor concerned with a three, seven, or ten days label* 
attached, according to the urgency of the demand. On receipt 
from the contractors of lists of articles which they were unable 
to supply within the specified period, indents for these were 
sent to the Army Medical Store or Army Medical Reserve 
Store, as the case might be, for supply. If the indents con- 
tained any articles which the Army Medical Stores were unable 
to supply, the officer in charge at once reported to the War 
Office, when special arrangements were made to procure them 
from the trade, or to expedite their supply by the contractors. 
A departure from this procedure was made in the case of the 
majority of the stores of which a six months' reserve was 
maintained, the indents for these stores being passed direct to 
the Army Medical Stores instead of being passed to the con- 
tractors in the first instance. 

The number of indents for medical stores and equipment 
received at the War Office between the 4th August, 1914, 
and 3rd August, 1919, was over 107,300 ;f of this number 
over 54,500, or an average of nearly 50 a day, were received 
during the first three years, and 52,800, or an average of 72 
daily, during the remaining two years, A very large number 
of these indents, especially those received from medical store 
depots overseas, included many hundreds of items, necessitating 
the placing of large orders with many different contractors, 
so that an immense amount of work was involved in dealing 
with them. 

Owing to the vast quantity of medical and surgical stores 
and equipment which had to be provided, the medical authori- 
ties were obliged to purchase from firms other than the regular 
contractors. More than 800 firms were consequently employed 

* The 3-day label was coloured red to show urgency ; the 7-day label 
green, and the 1 0-day label blue. The instructions on the label were as follows : 
" The full quantities of every item on this indent must be packed and ready 
for despatch within days of its receipt. If you are not in a position to 
comply with this order, you must, within 24 hours of the receipt of the indent, 
send to the Inspector of Medical Supplies, War Office, a complete list of what 
you are unable to supply within the days specified." 

f See Appendix E, Table III. 



MEDICAL AND SURGICAL EQUIPMENT 165 

in meeting requirements and over 5,200 special contracts were 
made. Some idea of the extent of the purchases may be formed 
from the fact that whereas the average expenditure on medical 
stores was only 28,500 per annum for the three years 
preceding the war, 475,962 were spent during the financial 
year 1914-15, 2,656,335 in 1915-16, 2,700,863 in 1916-17, 
3,961,932 in 1917-18, and 3,009,928 during 1918-19. After 
the Armistice there was a steady decline in expenditure on 
medical and surgical supplies, the monthly expenditure falling 
from 274,305 during the month previous to the Armistice, 
to 53,151, which included sums paid by way of compensation 
for cancellation of contracts in July, 1919. 

Very considerable difficulty was experienced in obtaining 
supplies during the early months of the war until the various 
medical and surgical supply trades were sufficiently expanded 
and organized to cope with the rapidly growing needs. To 
meet the difficulty special reserves of medical stores were 
accumulated as rapidly as possible, a careful system of card- 
indexing the arrears of contractors was introduced by Captain 
A. White-Robertson, R.A.M.C., who was detailed for the 
purpose of systematically visiting the firms, with the result 
that the balance of supply and demand was gradually restored, 
and although the amount of medical and surgical stores 
assumed immense proportions the arrears in their supply no 
longer caused anxiety. 

Medical equipment and stores for the whole of the military 
hospitals in the United Kingdom and with the armies over- 
seas were provided and maintained. Enormous quantities of 
surgical dressings were issued to the armies in the field and 
to the hospitals at home.* For example, 109 million bandages, 
sufficient to go nearly fourteen and a half times round the world, 
over 87,721 miles of gauze, and over 7,251 tons of cotton-wool 
and lint were supplied during the five years, August, 1914, to 
August, 1919. A considerable saving was effected by large 
issues of medicated and plain sphagnum moss dressings, other- 
wise the quantity of cotton-wool and other dressings material 
would have been much larger. In addition, a reserve of surgical 
dressings calculated to last for six months was maintained 
in the Army Medical Stores at Woolwich. This reserve was 
subsequently increased to twelve months' supply owing to the 
increasing difficulties in obtaining adequate supplies and the 
increasing risk of losses due to submarine warfare. 

The arrangements for the despatch of medical stores overseas 
at times gave rise to much trouble and anxiety owing to the 

* See Appendix E, Table IV. 



166 MEDICAL HISTORY OF THE WAR 

delay involved in shipping and transhipping stores to their 
destination. This was especially the case after the submarine 
menace became serious in 1917. Elaborate instructions were 
issued from time to time to contractors and the Army Medical 
Stores with a view to expediting despatch and preventing the 
miscarriage of stores. Close on 553,000 cases and bales of 
medical stores, amounting to more than 84,000 shipping tons 
were despatched overseas during the war.* The total losses 
of medical stores at sea resulting from enemy action amounted 
to 5,000 cases and bales, valued at about 70,000. 

Sixteen base depots of medical stores were established with 
the various armies in the field ; five in France (Nos. 1, 2, 3, 
6, and 13), three in Salonika (Nos. 7, 9, and 12), three in 
Egypt (Nos. 4, 5, and 8), one in Mesopotamia (No. 10), one at 
Bombay (No. 11), one in Italy (No. 14), and two in North 
Russia (Nos. 15 and 16). From all of them very frequent 
indents for immense quantities of medical and surgical stores 
of all kinds were received. The earlier of these base depots 
originally took out an average of 40 tons of medical stores in 
1,000 cases, but the later depots took 90^ tons in 1,850 cases,f 
and all of them expanded to great dimensions after they had 
opened overseas. In addition to these, medical store depots 
were established at Cairo, Malta, Nairobi, and Dar-es-Salaam, 
as well as thirty advanced depots in the various areas of 
operations. 

The medical equipment for all the regimental and medical 
units of the vast armies in the various fields of operations had 
to be provided on their mobilization and afterwards replenished. 
This included the equipping of 206 field ambulances, 76 casualty 
clearing stations, and 134 general and stationary hospitals. 
In addition to these, 66 hospital ships and 772 transports were 
also equipped ; 32 of the former being provided with X-ray 
installations and 24 with apparatus for the production of 
hypochlorite solution by the electrolysis of salt water. When 
special types of shallow-draught hospital steamers (130 to 200 
beds) and auxiliary hospital barges (100 beds) were designed for 
river work in Mesopotamia, 29 of the former (19 fitted with 
operation theatres) and four of the latter were provided with 
a special scale of medical and surgical equipment. 

The equipment of units involved the supply of nearly 129,000 
complete medical and surgical panniers, medical companions, 
surgical and shell dressing haversacks, fracture boxes, reserve 
dressing boxes and water-testing cases, in addition to about 

* See Appendix E, Table V. 

t No. 14 Base Depot, which went to Italy, and No. 15, which went to North 
Russia, took about 60 tons of additional stores with them. 



MEDICAL AND SURGICAL EQUIPMENT 167 

1,750 tons of other medical stores.* Owing to the necessity 
for somewhat elaborate fittings in order to economize space, 
the field medical equipment took a considerable time to procure 
and a large reserve of this class of equipment was consequently 
maintained in the Army Medical Store. 

Many additions were made to the scales of the field medical 
equipment of the various medical units as a result of the 
experience gained during the war. The contents of a base 
depot of medical stores and the medical and surgical supplies 
of a general hospital were also completely revised and more 
than doubled in quantity. For example, the cases and bales 
in a base depot were increased from 722 to 1,850 and the weight 
from 25 tons to 90| tons, as noted above, and those in a general 
hospital from 180 cases to 367 with an increase of weight from 
6 tons to 14 tons. 

Owing to the scarcity of aluminium, the contents of the 
field fracture box had to be revised in order to replace aluminium 
by malleable steel. This involved the preparation of fresh 
instructions, new patterns and drawings. The malleable steel 
and the new method of joining the pieces required to make the 
various splints proved a great improvement on aluminium and 
on the former method of jointing. 

A new pattern field operating table was designed, the former 
pattern having proved too weak and flimsy. 

Special first-aid outfits were designed for use with aeroplanes 
and tanks. 

Iodine ampoules containing 30 minims of tincture of 
iodine were introduced in the early days of the war for 
use in conjunction with the first field dressings which contained 
gauze impregnated with 2 per cent, to 3 per cent, by weight of 
double cyanide of mercury and zinc. In July, 1917, "however, 
it was represented from France that the consulting surgeons 
there were of opinion that the addition of iodine to the first 
field dressings served no useful purpose, and caused blistering 
of the skin in many cases when used in conjunction with 
cyanide gauze. Consequently, after careful consideration of 
the whole question in all its aspects by the consulting surgeons 
at home and abroad, it was decided to abolish the use of the 
iodine ampoule in conjunction with the first field dressing. 

The adoption of sterile, unmedicated first field dressings had 
been previously considered and rejected on the grounds that 
no such dressing could be kept sterile more than a few weeks, 
that the jaconet wrapper would not stand the heat of an 
autoclave, and that an " antiseptic " dressing was preferable to 

* See Appendix E, Tables VI, VII and VIII. 



168 MEDICAL HISTORY OF THE WAR 

a "sterilized aseptic" dressing, when the fact was considered that 
the dressing was always liable to be contaminated during appli- 
cation in the field, even although the existing dressings were 
carefully prepared and free from pathogenic organisms. 

The white bandage of the first field dressing had to be 
replaced by a khaki bandage as the former was considered to- 
be too conspicuous in the field. Much trouble was experienced 
in devising a suitable khaki dye which would produce the 
required colour without causing deterioration of the bandage, 
and at the same time prove harmless if brought into contact 
with the wound. The first process used, permanganate of 
potash and glucose, had to be abandoned as it was found 
to weaken the bandage, and a dye composed of cutch, 
fustic extract and copper sulphate was adopted and proved 
satisfactory, 

An enlarged form of first field dressing was introduced in 
March, 1915, for application to the large shell wounds for 
which the regulation first field dressings were too small. These 
were supplied in haversacks containing twelve shell dressings 
each, and a definite scale was laid down for regimental 
and field medical units, and as a reserve for replenishing 
haversacks. 

In March, 1915, a committee, composed of the professor of 
military surgery and two eminent London operating surgeons, 
was assembled at the War Office for the purpose of revising 
and standardizing the scale of surgical instruments authorized 
for military hospitals and bringing it thoroughly up to date. 
All the sealed patterns were assembled and carefully inspected, 
old patterns were discarded, new patterns selected, a large 
number of new instruments added, and scales drawn up for 
different classes of hospitals. Some hundreds of thousands of 
surgical instruments were purchased from the principal manu- 
facturers and delivered at the Army Medical Store, where they 
were submitted to careful inspection by experts before being 
taken into stock. A large number was rejected and had to be 
replaced by the contractors. 

Some difficulty was experienced in the early months of the 
war in obtaining a sufficient number of reliable clinical thermo- 
meters and arrangements were subsequently made to employ 
only the best makers of those instruments. A number of 
thermometers taken from each consignment was tested at the 
National Physical Laboratory, and if 5 per cent, failed to 
pass the test the whole consignment was rejected. Arrange- 
ments were made later to test all the thermometers manu- 
factured for the army so as to ensure a supply of uniformly 
reliable instruments. These measures resulted in the supply 



MEDICAL AND SURGICAL EQUIPMENT 169 

of excellent thermometers, the total issued during the war 
amounting to 1,086,000. 

Various designs of mobile operating theatres, with and with- 
out X-rays, were submitted to the War Office, but no mobile 
operating theatre similar to the "Automobile Chirurgicale " 
used in the French Army was evolved. An improvised 
arrangement, described as the " Wallace-Cowell Theatre 
Trailer," attached to a motor lorry was, however, prepared 
in France as an outcome of instructions issued from G.H.Q. 
for all casualty clearing stations to have ready a schedule of 
equipment for the rapid advance of a light section such as 
would be capable of forming an advanced operating centre in 
a war of movement.* 

Mobile laboratories of various kinds were designed and 
equipped for bacteriological, hygienic, X-ray and ophthalmic 
work at the front, and twenty-five bacteriological, ten hygiene, 
and fourteen X-ray mobile laboratories were sent overseas. f 
In addition, a mobile giant eye-magnet, specially designed by 
the medical supplies branch at the War Office, was sent to 
France. 

Five motor dental cars were presented to the British Army 
and sent to France. 

X-ray outfits suitable for the requirements of field service 
and hospital ships, as well as for military hospitals at home 
and abroad were designed. Eight different types including 
motor and trolley outfits were brought out during the war, 
and 528 outfits were supplied, a reserve calculated to last six 
months being maintained in store. 

The maintenance of these outfits involved the supply of 
a very large number of X-ray tubes and X-ray plates, over 
4,100 of the former having been issued during the two years 
prior to the signing of the armistice. Thousands of indents 
were received and many of these included spares and replace- 
ments, amounting in the aggregate to a large number of complete 
outfits. The expenditure on photographic accessories alone 
amounted to a very large sum. Thus, for the year ending 
3rd August, 1917, the amount spent was 52,000. 

The work of the X-ray section at the War Office became 
highly technical, involving, as it did, not only the inspection 
and testing of every outfit, but the design of new outfits, and 
of many new contrivances to render the equipment suited to 
war conditions. A well-illustrated book of instructions was 
issued to enable operators without previous field experience to 

* See Journal of the R.A.M.C., vol. xxviii, p. 708. 
f See Appendix E, Table IX. 



170 MEDICAL HISTORY OF THE WAR 

become familiar with the various types of field service outfit.* 
The designs included an outfit specially suitable for X-ray 
work at casualty clearing stations, and a special X-ray table 
combining the functions of the tube stand, table and vertical 
screening stand of the earlier oufits. A portable form of 
local izer designed at the beginning of the war was very widely 
used and proved to be capable of the most accurate localization. 
A light wooden portable folding tube stand was made for the 
portable trolley. An X-ray film was produced in 1917 which 
possessed the advantage of greater safety in transit, but the 
difficulties of handling and drying militated against its general 
adoption. 

On testing the outfits obtained from contractors during the 
earlier days of the war, it was found that they did not suffi- 
ciently protect the operator when working under war condi- 
tions. Many of the outfits had, therefore, to be re-designed and 
fitted with reinforced protection. Apparatus had also to be 
designed for ascertaining the extent of the protection afforded 
by those outfits which had already been issued. 

Difficulty was experienced in obtaining satisfactory X-ray 
and valve tubes, America being practically the only source of 
these when the German supply was cut off. Encouragement 
was consequently given to the British manufacturer by the 
purchase of British-made tubes, where such a course was 
consistent with efficiency. As a result, 40 per cent, of the tubes 
required by the army were being produced in Great Britain by 
1917. Much assistance was given to manufacturers by the War 
Office and by the research department of the Advisory Council, 
which undertook research in connection with X-ray tubes, with 
the result that the quality of English X-ray tubes approached 
the high quality of those of American manufacture. In the later 
years of the war the hot cathode X-ray tube was supplied in 
much larger quantities in view of its distinct advantage over the 
gas tube. 

At the end of 1915 a committee of experienced radio- 
logists and physicists was formed, under the chairmanship of 
Lieut. -Col. Archibald D. Reid, to assist the X-ray section of 
the Army Medical Supply Branch. This committee dealt with 
a variety of important technical details. They inspected and 
advised on technical matters connected with the X-ray depart- 
ments of hospitals ; assisted in the design of the various types 
of X-ray outfits ; drew up specifications for X-ray apparatus 
and materials ; examined and tested new X-ray appliances of 
all kinds, both from the medical and physical aspects ; designed 

* " Field Service X-ray Outfit Instructions," a book containing 69 closely 
printed pages, with numerous illustrations and diagrams. 



MEDICAL AND SURGICAL EQUIPMENT 171 

the apparatus for testing in situ the efficiency of the protection 
afforded by X-ray appliances ; designed laboratory methods of 
testing, and carried out the routine testing of X-ray appliances 
such as coils, interrupters, fluorescent and intensifying screens, 
and protective material ; prepared instructions to be observed 
by operators for protection from the harmful effects of X-rays ; 
reported on and tested the most suitable designs of a generating 
set for X-ray work ; designed the vehicle for mobile X-ray 
outfits and a mobile eye-magnet ; designed an X-ray register 
and ward report forms ; advised regarding the placing of con- 
tracts for X-ray equipment ; supervised the assembling and 
storing of X-ray apparatus and equipment ; classified for repair 
apparatus returned in an unserviceable condition ; carried out 
experimental and research work, and trained orderlies in prac- 
tical radiology and in the care, use and repair of X-ray apparatus. 
The committee also undertook during the later years of the war 
to grade officers of the R.A.M.C. in their knowledge of radio- 
graphy ; and for this purpose a number of distinguished 
radiologists was added to it. 

Through the kindness of the Governors of the Imperial 
College of Science and Technology, the War Office X-ray 
committee had the facilities of the physics department and 
workshops of that institution placed at their disposal, and 
accommodation of over 10,000 square feet was provided for the 
storing and testing of X-ray equipment and for instructional 
work in radiography and in the care and use of X-ray apparatus. 
A suitable staff under the direction of the committee was 
appointed by the War Office for the work involved. The 
staff included an expert officer in charge, a lecturer in radio- 
graphy, three physicists, and nine others as electricians and 
for carpentry, storekeeping and other duties. By the establish- 
ment of a store for X-ray apparatus, in close association with 
the physics laboratories and workshops, very thorough testing 
of outfits was facilitated and much efficiency was obtained by 
the training of orderlies at an institution where they could 
obtain experience with every type of apparatus in army use. 
In January, 1919, the War Office X-ray laboratory was trans- 
ferred from the Imperial College of Science and Technology 
to Hortensia Road, Fulham, and in July of the same year was 
divided into two departments ; one for testing only, and the 
other for storing and issuing equipment. 

Owing largely to the depletion of the staffs of manufacturers 
through the men being urgently required for military service 
and to the increasing requirements of other Government 
departments, it was evident early in 1918 that, should the 
war continue throughout the year 1919, it would be impossible 



172 MEDICAL HISTORY OF THE WAR 

to obtain the army's requirements in X-ray and electro-medical 
equipment under the then existing conditions of trade organiz- 
ation. Consequently, after conferring with other Government 
departments, the contracts department of the War Office 
decided to control the industry with a view to increasing 
output by the standardization of production. A committee 
of representatives of Government departments was then formed 
to carry out the work of standardizing requirements, and 
the War Office representatives undertook the preparation of 
complete specifications of all the items of equipment which 
could be purchased in common by the various departments 
through the War Office contracts department.* This com- 
mittee continued active until the date of the Armistice, and by 
that time had practically completed the work of standardiza- 
tion of the apparatus and the preparation of specifications. 
On the signing of the Armistice, the suggested control of the 
X-ray and electro-medical trade was abandoned. 

With regard to the supply of spectacles to serving soldiers, 
to which reference has been made in connection with recruiting, 
an army spectacle depot was established early in 1916 under 
the management of Mr. J. R. Sutcliffe at Clifford's Inn Hall, 
kindly placed at the disposal of the Army Medical Department 
by the British Optical Association, and 93 ophthalmic centres 
were established in the various Home commands by the end of 
the war, each centre being in charge of an ophthalmic surgeon, 
assisted by an enlisted qualified optician. Thirty-one similar 
centres were also established in France, Egypt, Mesopotamia, 
Salonika, Malta, and Gibraltar. At these centres all soldiers 
with defective vision, whose efficiency was materially affected, 
were carefully examined and supplied at the public expense 
with suitable round-eye army pattern spectacles of excellent 
quality, made up in accordance with the ophthalmic surgeon's 
prescription, the necessary frame measurements being recorded 
thereon by the optician. The ophthalmic centres both 
at home and abroad were equipped with ample stocks of 
spectacle frames and lenses and with all the necessary modern 
ophthalmic and optical appliances. 

Originally intended only for the fulfilment of spectacle 
prescriptions, the army spectacle depot eventually supplied all 
the spectacles, artificial eyes, optical tools and ophthalmological 
apparatus, such as cases of trial lenses, fitting sets, trial frames, 
lamps and test types, necessary to meet the requirements of 
the army both at home and overseas, and also carried out the 
repair of spectacles. The depot employed a staff of about 

See Appendix E, Tables XI and XII. 



MEDICAL AND SURGICAL EQUIPMENT 173 

eighty, all except six being girls. It was well equipped with 
grindstones, surfacing machines and other plant. The great 
expansion of the work of the depot necessitated the erection of 
two large huts at Clifford's Inn. A record of every pair of 
spectacles supplied under the scheme was kept. The spectacle 
frames supplied by the depot were made of non-tarnishable 
white metal of the best quality and workmanship, with curl 
cable sides, and were mostly of British manufacture. Forty- 
eight different fittings were kept in stock and were altered when 
necessary to meet exceptional measurements. The lenses were 
of the best white crown glass ; most of them were surfaced by 
various outside lens manufacturers, but the more intricate and 
deeper curves were surfaced at the army spectacle depot. 
Nearly all the lenses used were received in an uncut state, the 
circular bevel edging being completed by the staff of the depot. 
Each pair of spectacles was supplied in a metal case. Over 
193,700 pairs of spectacles were issued during the war to home 
centres alone, and, in addition, 156,271 frames, 472,488 lenses 
and 125,861 spectacle cases were supplied to ophthalmic centres 
and base depots overseas. During the first few months in 
which the scheme was in operation the average number of 
soldiers supplied with spectacles at home was 1,000 monthly ; 
the numbers eventually averaged about 5,000 per month and 
included supplies to the Dominion contingents and certain of the 
Allies in England, as well as to soldiers discharged to pension. 

In addition to the provision of spectacles, the army spectacle 
depot designed and arranged for the manufacture of a special 
pattern of sun-goggle, 300,000 pairs of which were sent out 
to the troops in Egypt and Mesopotamia early in 1916. Since 
that date material improvements in the pattern, including the 
substitution of glass for celluloid eye-pieces, were effected at 
the depot. 

Considerable difficulty was experienced in obtaining an 
adequate supply of artificial glass eyes, which before the war 
were chiefly obtained from enemy countries. To meet the 
difficulty stocks held in the United Kingdom were purchased or 
requisitioned and endeavours were made to increase the manu- 
facture of artificial eyes in England.* In order to make the 
best use of the available stock of eyes, an artificial eye centre 
was established in each command, to which all cases requiring 
artificial eyes were sent. These centres were kept supplied with 
artificial eyes from the large central stock at the army spectacle 
depot. The supply of artificial eyes was taken over by the 
depot in December, 1916, but the actual purchasing was 

* There were only about six actual makers in this country and they were 
averse from teaching others their trade. 



174 MEDICAL HISTORY OF THE WAR 

transferred in April, 1917, to the Optical Munitions Glass Depart- 
ment. The total number of artificial eyes procured from the 
'trade both by ordinary purchase and requisition between 
December, 1916, and 3rd August, 1919, was 88,412, of which 
22,386 were issued to the ophthalmic centres. A portion of 
this quantity was issued in the form of cases, each containing 
150 assorted eyes. 

Owing to the extreme difficulty of obtaining special artificial 
eyes for deformed sockets and to the lack of facilities for taking 
suitable measurements, the existing stocks of artificial eyes at 
the depot were largely increased by purchases of ordinary and 
abnormal shapes from all possible sources. The superintendent 
of the army spectacle depot visited Paris to study French 
systems of manufacture, and eventually arrangements were 
made whereby a staff of about twenty girls was employed in 
classification, matching, alterations, and glass-blowing. Small 
glass-making furnaces were installed with the object of research 
and making of the various enamels as used in the German 
systems. 

With regard to dental equipment, five different dental outfits 
were designed to meet the requirements of dental surgeons and 
dental mechanics at home and overseas, and 1,867 of these 
outfits were issued.* The specifications of these outfits were 
revised from time to time, as increased experience was gained 
in army dentistry. Special equipment was provided for new 
dental centres which were established in certain hospitals for 
the treatment of jaw injuries, and special equipment was also 
supplied to command dental workshops, each of which 
employed from 20 to 100 dental mechanics. 

All the materials required by the army dental surgeons and 
mechanics at home and overseas were provided through the 
medical supplies branch of the War Office. Heavy demands 
from the India Office, the Royal Air Force, and Dominion 
Contingents overseas were also met through the same agency. 
The total number of indents issued exceeded 18,100, involving 
the supply of about four million artificial teeth, between six 
and seven hundred tons of plaster of Paris, and 13 tons of 
dental rubber. 

To meet the extension of dental treatment in the army, 
arrangements were made in 1918 for the further purchase of 
400 home dental outfits for early delivery. This could only be 
effected by approaching the various civil dental hospitals and 
schools throughout the country with a view to the hire or 
purchase of any dental chairs or dental engines which were 

* See Appendix E, Tables XIII. XIV, XV and XVI. 



MEDICAL AND SURGICAL EQUIPMENT 175 

surplus to their immediate requirements. Nearly 140 chairs 
and a few engines were readily obtained in this manner. 

Electro-medical and mechano-therapeutic equipment con- 
sisted chiefly of : 

Switchboards : 

(1) Galvanic and Faradic. 

(2) Galvanic only. 

(3) Sinusoidal. 
Tables : 

(1) Galvanic and Faradic. 

(2) Faradic. 

Universal earth-free machines. 

Vibrators for massage, electrically driven. 

Radiant heat baths, including portable limb and 
trunk baths, also Dowsing radiant heat apparatus. 

Galvanic and Faradic batteries for treatment and 
muscle and nerve testing. 

Arm and foot cells. 

Schnee four-cell baths. 

Diathermy and high frequency apparatus. 

Condenser muscle-testing sets. 

Electrodes of various kinds, with connecting cables. 

Ultra-violet light apparatus. 

These types of apparatus were supplied to 24 command depots 
and orthopaedic and convalescent hospitals, and to a large 
number of military hospitals. 

For command depots and camp convalescent hospitals where 
it was not economical to run the electrical generating plant 
during the daytime merely for the purpose of supplying current 
for electrical treatment a storage battery system was designed 
in conjunction with the engineering branch of the War Office 
concerned, which enabled the radiant heat baths to be switched 
on and off without interfering with the constancy of voltage 
requisite for galvanic treatment. 

During 1917 a committee of electro-medical and physical 
experts rendered valuable assistance in standardizing the 
equipment and advising on technical matters. Specifications 
of standardized equipment, involving the design of apparatus 
specially suited to military requirements, were prepared. 

Special appliances were designed which made it possible to 
give galvanic treatment from the mains in such a way that the 
possibility of earth-shocks was eliminated. Great economy was 
thus effected as the necessity for installing an expensive earth- 
free battery or motor-generator was obviated. The electrodes 
and connecting cables issued were reduced to the simplest 
forms consistent with efficiency, the standardized equipment 



176 MEDICAL HISTORY OF THE WAR 

being fitted with special universal terminals of simple design to 
accommodate the standardized cable ends. A book of instruc- 
tions in the use of the standardized electro-medical equipment 
was prepared by the War Office electro-medical committee. 
It dealt with both the medical and physical aspects of the subject 
and included a complete schedule of articles of electro-medical 
equipment issued by the War Office. 

Various mechano-therapeutic apparatus were also supplied, 
such as massage plinths, peg posts, pulley weight machines 
with rowing attachments, pulley weight machines for wrist 
work, nautical wheels, frictional wrist machines, stationary 
cycle exercisers, finger grip exercisers, Indian clubs, medical 
stools, and wall bars. A special combination exercising machine 
combining most of the features of the above apparatus, at which 
a number of men could exercise at the same time, was designed. 
The machine was made by the patients undergoing treatment 
and instruction in trades in the Military Orthopaedic Hospital, 
London, and was supplied to the various treatment centres.* 

Special scales of equipment for military orthopaedic hospitals 
were introduced in consultation with the Inspector of Military 
Orthopaedics and other experts. 

During the war a large number of special splints and fracture 
apparatus was designed for the treatment of compound fractures 
complicated with extensive septic wounds.f An exhibition of 
splints and suspension and extension apparatus for the treat- 
ment and transport of fractures was held at the Royal Society 
of Medicine in October, 1915. The exhibits attracted much 
attention. Scale drawings were made from which the apparatus 
could be constructed and installed in various military hospitals 
both at home and overseas. A universal suspension apparatus 
and a net frame were designed by means of which patients 
suffering from fractures complicated with extensive wounds 
could be suspended and their wounds treated without interfering 
with the extension of the fractured limb. Patterns were made 
by one of the war hospital supply depots and were supplied to 
military hospitals in France and military orthopaedic hospitals in 
the United Kingdom to enable further sets of the apparatus to be 
manufactured locally. At the request of the Director-General 
of Medical Services in France, with a view to standardization 
of patterns, the consulting surgeons there rendered valuable 
assistance in 1917 in considering the most suitable designs 

* See Appendix E, Table XVIII. 

f Some of these are described in a " Memorandum on the Treatment of 
Injuries in War " officially published in July, 1915, and further modifications 
were published in the British Medical Journal of 16th December, 1916. A new 
edition of the Memorandum was published in January, 1918, under the 
title " Manual of Injuries and Diseases of War." 



MEDICAL AND SURGICAL EQUIPMENT 177 

and patterns of splints and apparatus for general use, and 
eliminating the infinite variety that had accumulated in 
depots to suit individual tastes. Fifty varieties were selected, 
and a reserve stock of about 200,000 was maintained in the 
Army Medical Reserve Store at Woolwich to meet demands 
from depots and hospitals overseas.* The standard patterns 
were adhered to as far as possible, but special designs were 
authorized and supplied to meet the requirements of special 
cases. Splint-making shops were established at Boulogne, 
Calais, Alexandria, and Salonika for the manufacture of all 
kinds of splints and similar appliances which could be made of 
wood, metal, and leather. These workshops were fitted with 
the requisite plant and tools, and experienced workmen 
employed in them. Although nearly a million and a half 
standard splints purchased under contract in England were 
supplied to the armies in the field, these factories largely 
supplemented the supplies, and, in addition, turned out large 
numbers of splints of special patterns and designs. Similar 
splint shops were subsequently established in the orthopaedic 
hospitals in the United Kingdom. 

Cutler's shops for the repair and sharpening of surgical 
instruments were established at Boulogne, Calais, Rouen, 
Abbeville, Alexandria, and Salonika. Each shop was fitted with 
the requisite power, plant (grindstone, polishing and buffing 
wheels, anvils, lathes, filing and fitting benches), and tools, 
and experienced instrument makers were employed. Electro- 
plating plants were also installed at the workshops at Abbeville, 
Calais, and Alexandria. A large amount of repair work was 
carried out in these shops, and by means of them surgical 
instruments in use at casualty clearing stations, general hospitals, 
stationary hospitals, and other medical units in the field were 
repaired, sharpened and returned without the delay and expense 
which would have been involved by sending the instruments to 
contractors in England for repair. 

By June, 1918, there was a large number of disabled soldiers 
on furlough waiting admission to hospitals for the fitting of 
artificial limbs. Experience showed that when artificial limbs 
were provided immediately after the stumps were healed the 
shrinkage of the stump quickly rendered a change of bucket 
necessary. It was found that this shrinkage did not definitely 
progress until the stump was brought into use, and it was found 
necessary, therefore, to pro vide a simple temporary limb pending 
the completion of the shrinkage of the stump. At a conference 
held at the medical department of the War Office at the end 

* Some of the more commonly used splints are enumerated in Appendix E, 
Table XVII. 

(1735) N 



178 MEDICAL HISTORY OF THE WAR 

of August, 1918, it was decided that the plaster pylon was the 
most suitable for this purpose as well as the simplest to 
make and the easiest to adjust or re-make when necessary. 
A memorandum was consequently published giving details of 
the method of manufacture of the pylon ; officers from over 
100 military hospitals were sent to various centres for instruc- 
tion in making pylons, and the necessary wooden base blocks, 
side bars, struts, rubber heel pads, felt, flannel, muslin, webbing, 
plaster of Paris, buckles, and screws for their manufacture 
were supplied to these hospitals. At an Inter- Allied Conference 
on the after-care of disabled men held in Rome in October, 1919, 
the general opinion expressed was to the effect that these 
temporary limbs should be regarded as a therapeutic measure 
for the preparation of the stump rather than as a means of 
locomotion, and that the plaster pylon accurately fitted to 
individual stumps was the best form of temporary limb. 

With regard to drugs, it was foreseen in the early days of 
the war that it would be necessary not only to prohibit the 
export of certain drugs but also to encourage their manufacture 
in this country in order to guard against a shortage. Both these 
steps were taken, with the result that there was at no time 
any actual shortage of essential supplies, although there were 
temporary difficulties from time to time in obtaining what was 
required, and in some instances substitutes had to be adopted. 
Thus, owing to the necessity of allocating the total production 
of glycerine for the manufacture of explosives, the supply of 
glycerine for medicinal purposes was stopped by the Ministry 
of Munitions in February, 1917, and substitutes such as glucose 
and treacle had to be found for those pharmacopoeia pre- 
parations which contained glycerine.* The use of carbolic 
and picric acids for surgical and antiseptic purposes was also 
restricted owing to the urgent need of these substances for 
explosives, and the employment of cresols in part substitution 
was adopted. Shortage in the supply of lard, oils and fats for 
food and the necessity for reserving most of the available 
supply of the highest grade of castor oil for aeroplanes made it 
necessary to find substitutes for these articles. 

British manufacturers were encouraged to manufacture 
synthetic coal-tar derivatives such as aspirin, antipyrin, 
phenacetin, salicylate of sodium, and novocain, and fine 
chemicals such as atropine, morphia, emetine, and permanga- 
nate of potash, all of which before the war were largely imported 
from Germany, with the result that not only were sufficient 
quantities produced in this country to meet the needs of the 
army, but the high prices ruling in the earlier part of the war 

* The use of glycerine was restored in January, 1919. 



MEDICAL AND SURGICAL EQUIPMENT 179 

were very materially reduced. Care was taken to ensure that 
in all cases the B.P. standard of purity was adhered to. Ether 
and chloroform for anaesthetic purposes were required in 
such enormous quantities that the Customs authorities were 
approached and special facilities were granted to the limited 
number of manufacturers of these drugs for augmenting their 
plant in order to increase the output to meet requirements. 

Not only did contractors keep heavy stocks of drugs to meet 
current requirements, but, in order to meet urgent demands 
from the armies in the field, a reserve of some 6,000 cases 
of the more important drugs was held ready for immediate 
despatch in the Army Medical Reserve Store, Woolwich. A very 
large reserve of some 250 million tablets was also maintained 
in the Reserve Store. The number of tablets of compressed 
drugs issued during the war amounted to 1,080 millions, in 
addition to a very large number of tubes of hypodermic and 
ophthalmic tablets. 

Quinine was in great demand and was very freely used as 
a prophylactic in the war areas where malaria was prevalent. 
It was mainly issued in the form of the four principal salts, 
sulphate, bisulphate, hydrochloride and bihydrochloride, a 
considerable portion being in tablet form. The demand in- 
creased with the increase of the forces operating in malarial 
districts until during the year 1916 the total issues exceeded 
twenty-one tons or nearly sixty-six million five-grain doses, 
while during the earlier part of the malarial season of 1917 the 
average amount supplied monthly was about 12,500 lb., or over 
five and a half tons. In 1918 the average monthly consump- 
tion amounted to some 10,000 lb. Considerable difficulty was 
experienced in obtaining this enormous quantity of quinine, and 
it was found necessary to have all stocks of the drug held in 
this country declared and to requisition nearly forty tons under 
the Defence of the Realm Regulations. A consignment of 
30,000 lb. was also obtained from India and sent direct to 
Salonika. 

Cases of indiscriminate sales by chemists and others of 
narcotic and other poisonous drugs to officers and soldiers 
having been brought to notice, the Army Council, in view of the 
inadequacy of the Pharmacy Acts for dealing effectively with 
such cases, decided to take steps under the Defence of the 
Realm (Consolidation) Regulations, 1914. An Army Council 
order was consequently promulgated on the llth May, 1916, 
with the concurrence of the Admiralty, prohibiting the sale of 
certain poisonous drugs to or for any member of His Majesty's 
Forces unless ordered for him by a registered medical prac- 
titioner on a written prescription duly signed and dated and 

(1735) N 2 



180 MEDICAL HISTORY OF THE WAR 

marked with the words "not to be repeated." By Army 
Council Instructions, dated 5th June and 8th August, 1918, 
the order dated llth May, 1916, was further amended and 
acetanilidum and phenacetin and any salts, preparations, 
derivatives, or admixtures, prepared from or with either of 
these drugs, were added to the schedule. 

The principal general anaesthetics employed for surgical 
operations were methylated ether, methylated chloroform, 
ethyl chloride, and nitrous oxide gas. Notwithstanding the 
statements to the contrary, which appeared in the public press 
and elsewhere, at no time was there any shortage, but special 
steps had to be taken, as noted above, to ensure adequate 
quantities being available to meet the very large demands 
submitted from depots of medical stores and military hospitals. 
The total amounts of ether and chloroform issued during the 
five years of the war were 413,198 Ib. and 249,341 Ib. 
respectively. The average monthly issues during the first seven 
months of 1917 amounted to 7,013 Ib. of ether and 4,901 Ib. 
of chloroform. The demands from France for ether were 
specially heavy, and amounted at one time, in September and 
October, 1918, to 3,000 Ib. per week, due to its being largely 
used in preference to chloroform. 

In order to meet the special requirements of the army, where 
anaesthetics have sometimes to be stored for a considerable 
time, a higher standard of purity of ether and chloroform than 
that usually required by civil hospitals was deemed to be 
necessary, and, acting upon the advice of the Council of the 
Section of Anaesthetics of the Royal Society of Medicine, steps 
were taken to ensure that all supplies, in addition to complying 
with the strict requirements of the British Pharmacopoeia, 
should pass two additional tests of purity. 

A new scale of anaesthetic outfit for operation theatres was 
adopted,* and a new form for recording the administration of 
anaesthetics introduced. 

In 1917 the demand for nitrous oxide gas and oxygen rapidly 
increased, as they proved more satisfactory than the other 
anaesthetics in cases suffering from severe shock. By the 
middle of that year the monthly requirements were 78,500 
cubic feet of oxygen and 300,000 gallons of nitrous oxide gas. 
The increasing use of these gases involved the issue of a very 
large number of cylinders, which had to be specially manu- 
factured ; but, owing to the demands for steel for munitions, 
some difficulty was experienced in obtaining sufficient cylinders 
to meet requirements. Over 14,000 oxygen cylinders and over 
8,000 nitrous oxide cylinders of varying capacity were in 

* See Appendix E, Table XIX. 



MEDICAL AND SURGICAL EQUIPMENT 181 

circulation for medical purposes by the end of 1917, and in 1918 
a further 7,500 oxygen cylinders and 3,000 additional nitrous 
oxide cylinders were purchased. Orders for 10,000 cylinders 
were cancelled on the signing of the Armistice. The oxygen 
cylinders supplied included 4,000 of a light type intended for 
use in the field with Haldane's oxygen inhalation apparatus.* 

Oxygen was supplied to home hospitals by the British 
Oxygen Co., while in France cylinders were refilled by French 
firms. All the other theatres of war were supplied through 
the Army Medical Store at Woolwich, empty cylinders being 
returned to this country for refilling as they became available. 
All the nitrous oxide gas required at home and overseas was 
also supplied through the Army Medical Stores. 

The provision of oxygen as a therapeutic agent for use in 
the army during the war was never on a thoroughly satisfactory 
basis. Prior to 1914 the employment of oxygen in clinical 
medicine was extremely limited. Consequently the demands 
from the medical profession were not sufficient to stimulate 
industrial effort for production and distribution on a large scale. 
Gaseous oxygen under pressure in large heavy steel cylinders 
was supplied and the user was obliged to accept it in these 
cumbersome containers. The excessive weight was a serious 
disadvantage from the point of view of transport and handling. 
There was often great waste of gas due to the want of know- 
ledge on the part of those administering it and also for the want 
of a device to control the flow and measure the quantity which 
it was intended the patient should receive.f This costly, 
extravagant and inconvenient method of distribution seemed 
to meet the demands of the civil population and that of the 
army during the early days of the war, but when the Germans 
used poison gas the need for oxygen on a large scale in the 
advanced medical units became acute and the problem of 
how the requirements could be met was difficult and anxious. 
Whether the necessary quantities of cylinders could be produced 
became a serious question. The matter was referred to the 
medical stores committee of the department of the Surveyor- 
General of Supply who, after considerable investigation and 
experiment, arrived at the conclusion that oxygen in a liquid 
form offered a solution of the difficulty, provided a suitable 
container in the form of a vacuum or thermos flask could be 
found. Glass containers, although specially protected, were 
found to be too fragile to withstand the rough usage inseparable 
from active service conditions, and, after numerous experiments 

* This was a special apparatus designed by Dr. J. S. Haldane, of Oxford. 
Over 450 sets were supplied to the medical services overseas. 

f The Haldane apparatus was designed to meet these requirements. 



182 MEDICAL HISTORY OF THE WAR 

in the workshop, satisfactory metal vacuum containers were 
produced. Before the signing of the Armistice in November, 
1918, arrangements had been completed to send a substantial 
amount of liquid oxygen to France in large containers with 
a number of tested vaporizers for use on the Western Front. 
A R.A.M.C. officer specially instructed in all details appertain- 
ing to this subject was in readiness to proceed in charge. 
Arrangements for a regular supply of liquid oxygen to be sent 
to this officer had also been made. But when hostilities ceased 
the necessity for oxygen in the advanced line medical units 
disappeared. The matter, however, was not lost sight of, and 
certain points in connection with it were from time to time 
referred to the Oxygen Research Committee of the Depart- 
ment of Scientific and Industrial Research for investigation 
under peace conditions. 

Provision for dealing with possible cholera outbreaks was 
made early in the war, and excellent cholera outfits were 
devised by Captain A. White-Robertson, R.A.M.C., for the 
treatment of cases on the lines recommended by Lieut.-Colonel 
Sir Leonard Rogers of the Indian Medical Service. Each of 
these outfits contained sufficient apparatus, chemicals and drugs, 
packed in two portable cases, to deal with a hundred cases 
of the disease. 545 outfits were distributed to the various 
areas of operations, namely, 62 to France, 112 to Egypt and 
the Mediterranean, 170 to Mesopotamia, 18 to Italy, 163 to 
North Russia, and 22 to Salonika. A reserve of 12 outfits 
was maintained in the Army Medical Store at Woolwich.* In 
addition to the outfits a reserve of expendible contents and 
certain hospital necessaries for the treatment of the disease 
were supplied to the base depots of medical stores overseas. 

The quantity of vaccines issued during the five years of the 
war amounted to over 34 million cubic centimetres, of which 
more than 24 million were for typhoid and paratyphoid, nearly 
7 millions for cholera, and well over a million for influenza. 
Altogether some 24 varieties of vaccines were prepared, prac- 
tically the whole of which were manufactured in the vaccine 
department of the Royal Army Medical College, thus saving 
the State the expenditure of many thousands of pounds sterling. 

Over 12 million doses of various sera were also issued,! 
11 millions of which were an ti- tetanic serum. In view of the 
experience gained from the study of tetanus during the war. 
it was considered necessary to extend greatly the use of 
anti-tetanic serum as a prophylactic, and this necessitated the 

* See Appendix E, Table XX. 

f See Appendix E, Tables XXI and XXII. 



MEDICAL AND SURGICAL EQUIPMENT 183 

preparation of a scheme for its distribution to the hospitals 
at home, as well as to units in the field. 190,000 phials of 
prophylactic sera for gas gangrene were prepared containing 
anti-bodies to B. Welchii, Vibrion Septique and Tetanus. A 
series of five varieties of high-potency sera was also provided, 
both monovalent and polyvalent. The actual issue of the bulk 
of these anti-gas-gangrene sera, however, was not made until 
the eve of the Armistice. Early in the year 1918 arrangements 
were completed through the Medical Research Committee for 
the provision of anti-endotoxic meningococcus serum, prepared 
at Cambridge, for the treatment of cerebro-spinal fever. The 
serum was supplied in all cases of cerebro-spinal fever occurring 
in the troops stationed in Great Britain. This supply was in 
addition to anti-meningococcus serum provided by the Lister 
Institute for issue to the overseas forces. For the treatment 
of influenza cases in the army, 10,046 phials of a special anti- 
streptococcus serum were issued, in the production of which 
cultures were employed prepared from strains isolated from 
actual cases of influenza occurring in France. During the year 
1918 a Central Military Laboratory was established at Cambridge, 
tinder the supervision of Colonel G. Sims Woodhead, for the 
manufacture, standardization and supply of the several reagents 
necessary in the conduct of the Wassermann reaction for 
syphilis. Some twenty hospital laboratories, especially selected 
in the Home commands, were then supplied with these reagents 
with a view to securing uniformity in the testing of suspected 
blood sera and cerebro-spinal fluids, and adopting an official 
standard test. This work was in full operation by July, 1918. 

The results obtained in France by Carrel's method of irri- 
gating wounds with Dakin's solution proved so satisfactory 
that arrangements were made to continue the treatment on 
hospital ships and ambulance trains as well as in hospitals at 
home. A pamphlet of instructions on the subject was prepared. 

Shortly after the outbreak of war the medical services were 
faced with the prospect of a serious shortage in the supply of 
scientific glassware and the increasing demands of glassware 
for medical, bacteriological, pathological and chemical purposes 
had to be met chiefly from the stocks of foreign-made articles 
held by merchants in this country. The amount produced in 
the United Kingdom was very limited, and efforts were made 
by various scientific bodies, such as the Institute of Chemistry, 
the Department of Glass Technology, Sheffield University, and 
the Government Department of Scientific and Industrial 
Research, to foster the manufacture of heat-resisting and special 
glassware for scientific purposes. The Optical Munitions 
Glassware Department of the Ministry of Munitions organized 



184 MEDICAL HISTORY OF THE WAR 

the trade and undertook to supply the medical services with 
the glassware necessary to meet requirements. Although 
delays occurred and to a certain extent inferior substitutes had 
to be accepted, an adequate and regular supply was maintained 
and no serious shortage was experienced. 

In connection with instructions promulgated in June, 1918, 
regarding the " early treatment of venereal disease," arrange- 
ments were made for the supply of the necessary materials 
and apparatus, and over five million capsules of calomel cream 
were issued for army use up to the end of October, 1919. 

From time to time advice was given to the Central Prisoners 
of War Committee of the British Red Cross Society and Order 
of St. John as to what medical stores and invalid comforts 
should be sent to prisoners of war camps in enemy and 
neutral countries. 

In 1915 Colonel Sir Edward Ward was appointed Director- 
General of Voluntary Organizations to co-ordinate the efforts of 
the numerous voluntary organizations, not under the British 
Red Cross Society, which were engaged in making various 
articles for the comfort of patients in military hospitals, but 
were not authorized for supply from official sources, such as 
bed-jackets, bed-socks, dressing gowns, hospital bags, pyjamas, 
slings, felt slippers, sphagnum moss dressings, operation swabs, 
specially prepared bandages, and so on. He was assisted in 
this work by Mr. A. Hutchings. The organization rendered 
invaluable service and added greatly to the comfort of the 
patients in military hospitals.* The British Red Cross Society 
and Order of St. John also supplied vast quantities of similar 
comforts to military hospitals in addition to what they supplied 
to Red Cross hospitals, and their gifts were very highly 
appreciated. 

In addition to the War Office X-ray and electro-medical 
committees, to which reference has already been made, various 
other committees and specialists were appointed and freely 
consulted as to the necessity or desirability of supplying 
articles of medical and surgical equipment which were asked for 
but which were not in general demand, and for advising on the 
very large number of new patterns and inventions and new 
methods of treatment requiring investigation and trial, f 
This entailed much work, involving as it did numerous 
interviews, the getting out of specifications and patterns, 
arrangements for manufacture, and so on. 

When the department of the Surveyor-General of Supply 
was organized in 1917 with the object of co-ordinating the 

* See Chapter XL 

t See Appendix E, Table XXIII. 



MEDICAL AND SURGICAL EQUIPMENT 185 

commercial side of the business of supplying the army, one of 
its committees, consisting of a commercial member as chairman, 
a representative of the Director-General of the Army Medical 
Service, a representative of the Director of Army Contracts, 
and a secretary, was appointed to deal with the supply of 
medical stores. The duties of this committee were to examine 
and, if advisable, suggest revision of demands in the light of 
available information as to stocks, rate of consumption and 
available transport facilities ; to consider the possible revision 
of patterns and specifications with a view to securing greater 
economy or removing difficulties of supply; to consider 
the adequacy of provision for existing or probable future 
requirements, and to make suggestions as to meeting such 
requirements.* 

With a view to ensuring the proper accounting for medical 
stores, the exercise of strict economy and foresight in making 
demands and the prevention of undue accumulation, extrava- 
gance and waste, some fifty circulars and fifty-three Army 
Council Instructions dealing with supply of medical and 
surgical stores were issued during the war.f 

After the outbreak of war, the duty of accounting for the 
receipt and issue of medical and surgical stores at military 
hospitals became a very difficult problem owing to the with- 
drawal of the trained staffs for service in the field. They were 
replaced by men who knew little or nothing of the method of 
accounting for medical stores, and it was found practically 
impossible to compile the necessary returns until they became 
conversant with the regulations and army forms used for 
accounts. At first instructions were issued for accounts to be 
kept for non-consumable stores only, thus safe-guarding as 
far as possible the most important class of stores from a 
financial point of view. In March, 1916, however, instructions 
were issued for the full accounting of all receipts and issues to 
be resumed as in peace time not only for hospitals but for all 
units at home.J 

In order to cope with the work involved in checking these 
accounts it became necessary to establish a special audit 
section in the directorate of medical services for the audit of 
the returns of medical stores, a difficult matter with a small 
and untrained staff, more especially as the returns were largely 
of a technical nature. Further, the manner in which the maj ority 
of the returns were compiled necessitated an immense number 

* Mr. W. J. Uglow Woolcock first represented the Director of Army 
Contracts on this committee and was subsequently appointed chairman, 
t See Appendix E, Table XXIV. 
} A.C.I. 629 and 647 of 1916. 



186 MEDICAL HISTORY OF THE WAR 

of " observations," in some instances close on 300, being sent 
back to accounting units. 

A special cash accounts section was also organized to receive, 
register, file, audit, and prepare for payment contractors' 
claims for medical and surgical stores, and to conduct the 
correspondence incidental to their settlement.* 

The investigation and preparation for payment of contractors' 
applications for advance payments was another important duty. 
An average of over 48,000 contractors' claims were dealt 
with each year. The section also revised and kept up to 
date the " Priced List of Medical Stores," and maintained 
the War Office stock ledgers, the record of receipts and 
issues of War Office stock, and dealt with other financial 
matters arising out of the purchase of medical and surgical 
stores. The staff of the cash accounts section was 23, 
nearly all of whom joined the medical department of the War 
Office without previous experience in accounting. The 
majority, too, had had no office training, and it is much to their 
credit that the work of accounting was so accurately performed. 
The system of ledger keeping for cash accounts adopted was 
so complete and satisfactory that it was made use of by the 
Finance and Audit Branch of the War Office, who found it 
unnecessary to keep a similar detailed record in their branch. 

During the first year and a half of the war, local purchase 
of medical stores had to be largely resorted to, and in the 

* In the audit of each account the contract rates were checked, quotations 
" agreed," prices and references to catalogues and price lists were verified, and 
rates which were not included in any of the foregoing categories were settled ; 
percentages, discounts, extensions and additions were computed, and the 
necessary adjustments were made in the invoices. Temporary deductions for 
" costings " were made and recorded, and these were finally adjusted on receipt 
of the report of the Contracts Department. Carriage and other charges were 
verified with vouchers, the rates for packing cases, bottles and other containers 
were checked, questions involving the interpretation of contracts were settled or 
referred to the Director of Army Contracts, and the contractors' claims were 
finally cross-checked with the certificates of stores credit. Duplicate claims 
were watched for, and all accounts were carefully filed after payment. The 
necessary certificates of receipt of stores were obtained from the various hospi- 
tals and depots at home and abroad to vouch payment of contractors' claims. 
All special contracts in their subsequent amendments were recorded and indexed 
in the contract ledgers ; particulars of deliveries, rejections, deficiencies, pay- 
ments, deductions for costings and other adj ustments were also recorded, and 
the ledger finally balanced for each contract. There were 18 of these ledgers 
in use. An invoice book was kept, recording the individual value and total of 
contractors' claims day by day. Systematic reminders were sent to officers 
in charge when documents connected with the settlement of accounts had 
not been returned and the return of invoices duly recorded. Contractors 
were notified of discrepancies in supply from shortages, breakages, non-delivery 
of stores, inaccurate descriptions, omissions from invoices, and so on, lost cases 
were traced, and all these discrepancies finally adjusted by credit, replacement, 
or " write off." Credit for returned empties and stores was secured and appro- 
priate empties ledgers duly kept. 



financial year 1915-16 the expenditure under this head 
amounted to 309,682. This was due mainly to three causes. 
On mobilization, the cost of the initial outfit of medical and 
surgical equipment for the territorial force general hospitals 
was met by local purchase ; the cost of dental treatment was 
made a local charge before the establishment of army dental 
workshops and the appointment of army dental surgeons; 
and the rapid raising of the new armies necessitated the 
local purchase of medical stores from the nearest available 
source. An Army Council Instruction was issued on the 
subject in 1916, and this, combined with the change of the 
system of dental treatment, was responsible for the reduction 
of local purchases to 84,303 in 1916-17, with further re- 
ductions in subsequent years of the war. 

In addition to supplying medical stores to the armies in the 
field and all the hospitals at home and abroad, heavy demands 
for medical stores required by the India Office, Dominion 
contingents, Air Ministry, Ministry of Pensions, Ministry of 
National Service, Ministry of Health and other Government 
departments, the United States Army and the Portuguese, 
Belgian, and Serbian Governments were met. The Local 
Government Board and the Board of Control in many 
instances were given the surplus medical and surgical 
equipment and stores which the Army Medical Service had in 
poor law institutions and asylums when military hospitals 
opened in them were demobilized. 

During the course of the war, drugs and dressings were also 
issued free from medical units in the field to the civilian popu- 
lation in areas occupied by the 1st, 2nd, and 3rd Armies in France. 
In the 1st Army area about 245 patients were treated daily 
at an approximate daily cost of 4 6s. Attendance and treat- 
ment were given by R.A.M.C. officers practically whenever and 
wherever it was asked for, owing to the poverty of the applicants 
and to the limited number of French doctors available. Fewer 
cases were treated in the areas occupied by the 2nd and 3rd 
Armies, treatment being limited in these areas mainly to cases 
of accidents occurring in the proximity of medical units. This 
service to the French civil population was greatly appreciated. 
It stimulated a spirit of friendship which was of much value 
and assistance, and, in 1916, it was decided to continue free 
treatment of this kind till the end of the war. After the 
signing of the Armistice it was discontinued, except for cases 
of emergency, in the areas occupied by the lines of communi- 
cation. 

In addition to this service to the French, 3,559 cases of medical 
and surgical stores, amounting to 55,738 in value, were supplied, 



188 MEDICAL HISTORY OF THE WAR 

in September, 1918, to the British supply mission at Archangel 
for the use of the civil population there ; and considerable 
quantities of medical and surgical stores were supplied in 1919 
from home and overseas depots of medical stores to allied 
forces in Russia and Siberia. These stores included medical 
and surgical equipment for medical units, regimental medical 
and surgical equipment, and advanced and base depots of 
medical stores. 

In August, 1919, 171 packages of medical and surgical stores, 
valued at about 4,500, were supplied from No. 14 Base Depot 
of Medical Stores in Italy, at the urgent request of the Inter- 
Allied Food Mission, Vienna, to meet the pressing needs of 
the civil hospitals in Vienna and Budapest. 

Immediately after the signing of the Armistice steps were 
taken to effect economy and reduce expenditure. The contracts 
branch was asked to cancel as far as possible outstanding 
contracts for medical supplies not required in view of the 
altered conditions ; in addition to several depots established 
at home, five special depots were established overseas at 
Boulogne, Calais, Etaples, Abbeville, and Rouen for the re- 
ception of stores handed in by units on demobilization ; stocks, 
surplus to requirements at home and overseas, were ascertained 
and arrangements were made for their redistribution where 
required, instead of meeting demands by purchase ; obvious 
surplus stocks were declared as such to the Surplus Government 
Property Disposal Board for sale ; medical stores, estimated 
at 276,000, for General Denikin's forces in South Russia were 
provided from surpluses in England, France, Malta, Egypt, 
Salonika, and Italy ; the mobilization field medical equip- 
ment of the Interim Army was provided from existing stocks, 
and from serviceable equipment brought home by cadres of 
units returning from overseas. 

Arrangements were made at the same tune to enable serving 
and demobilized officers of the R.A.M.C. and dental surgeons 
to purchase surgical and dental instruments and appliances, 
X-ray equipment, and aseptic furniture, which were surplus to 
army requirements. Stocks were held available for inspection 
in London, Woolwich, Liverpool, Bristol, Northampton, York, 
Portsmouth, Edinburgh, and Dublin. Large numbers of officers 
and ex-officers took advantage of this opportunity to secure 
for their own use on advantageous terms articles necessary for 
their practice on demobilization. 

It will be seen from this account of the supply of medical 
and surgical equipment and stores during the war that the 
Army Medical Department was able at all times to meet the 
heavy demands made on it, and that there was no lack at any 



MEDICAL AND SURGICAL EQUIPMENT 189 

time of the essential remedies and appliances required for the 
treatment of the sick and wounded. The task was one of 
extreme difficulty especially in the early days of the war ; 
and new difficulties were constantly arising. Enormous 
demands for stores and equipment of all kinds had to be com- 
plied with to meet the sudden and frequent expansion of hospital 
beds both at home and overseas. There was a multiplicity of 
indents marked " urgent," many of them for excessive quanti- 
ties of stores, the real necessity for which it was difficult or 
impossible for the central department to determine, although 
it was felt that the demand depended in many cases on the 
desire of the indenting authority to anticipate requirements 
or to meet a shortage which want of foresight had rendered 
imminent. Excessive demands were difficult to meet from a 
depleted market. Certain articles such as those usually supplied 
from foreign countries could only be obtained in restricted 
quantities until arrangements were made to manufacture them 
at home. Contractors often failed to keep to time with their 
deliveries owing to scarcity of material and labour ; shipping 
was not always available, and transit of stores by railway was 
sometimes delayed. Another source of delay was insufficient 
description of the article indented for, necessitating enquiries 
as to its exact nature. Notwithstanding these great and 
increasing difficulties the maintenance of the supply of medical 
and surgical equipment and stores was one of the most brilliant 
achievements of the medical services at the War Office during 
the war. This result could not have been attained without 
the cordial co-operation of the medical supplies branch of the 
Contracts Department, the loyal and patriotic support of the 
manufacturing and contracting firms, and the assistance of 
the expert committees. 



CHAPTER X 

SANITARY ORGANIZATION IN THE UNITED KINGDOM 



sanitary problems which the medical services en- 
countered at the beginning of the war teemed with diffi- 
culties. Situations arose of which the military and civil sanitary 
authorities had no previous experience and for which legisla- 
tion affecting public health had made no provision. Apart 
from the rapid accumulation of troops in camps throughout 
the country, large numbers of soldiers had to be billeted for 
the first time, at any rate in living generations, in the houses 
of the civil population, and the danger of the spread of 
infectious disease amongst soldiers and civilians alike caused 
much anxiety. Both camps and billets overflowed with 
recruits of the new armies who were as yet untrained in army 
sanitation, and, in many cases, the medical officers in charge 
of the new units were equally inexperienced. It is no matter 
of surprise, therefore, to find that numerous complaints reached 
the War Office in the earliest stages of the war regarding the 
conditions under which young soldiers were being housed and 
fed, and regarding outbreaks of preventible disease amongst 
them. But, although most of the complaints fortunately 
proved on investigation to be unfounded or much exaggerated, 
the need of active measures to meet' the sanitary situation was 
undoubtedly great. Before the war the number of troops serving 
in the garrisons at home varied but slightly from year to year. 
They were housed in permanent barracks and camps, and it 
was only during army manoeuvres, when they were temporarily 
quartered in civil sanitary districts, that military sanitary 
authorities came in touch with certain of the civil sanitary 
authorities in England. The arrangements then made were 
a matter of local agreement and it was quite exceptional for 
the Army Council and the Local Government Board to inter- 
vene with special arrangements made by higher authority. 
Legislation, as affecting the relationship between civil and 
military sanitary authority, was broadly to the effect that 
War Department premises and the individuals in occupation 
of them were outside the sphere of the local civil sanitary 
authorities.* The War Office made its own arrangements for the 

* See Sec. 327, Public Health Act, 1875 ; Sec. 9, Housing of Working 
Classes Act. J88S ; Sec. 15, Infectious Disease (Notification) Act, 1889. 

190 



SANITARY ORGANIZATION 191 

sanitary administration of barracks and camps, including 
water supply, sewerage and disposal of refuse, sewage, and so 
on ; civil medical officers of health were not entitled to receive 
notification of infectious disease occurring in War Department 
premises, and measures of isolation, disinfection, and other 
means of preventing the spread of infectious disease in such 
cases were legally no concern of theirs. In most cases, however, 
working arrangements of a more or less satisfactory kind were 
in operation between the local military and civil sanitary 
officers. Thus cases of infectious disease amongst soldiers and 
their families were frequently admitted into the civil isolation 
hospitals by mutual consent, and the general view of the 
Local Government Board and the Army Council was that there 
should be the fullest interchange of information regarding the 
prevalence of infectious diseases in the military and civil 
populations. 

The outbreak of war at once transferred the question of co- 
operation between the military and civil sanitary authorities 
from local arrangements in a few districts only to the considera- 
tion of general measures which would be applicable to all areas 
throughout the country ; and, for this purpose, the Director- 
General of the Army Medical Service, immediately war was 
declared, put himself into communication with Sir Arthur 
Newsholme, who was then the medical officer to the Local 
Government Board. From that time onwards, the Local 
Government Board and its medical services worked in close 
association with the War Office in all matters relating to the 
sanitation of billets and camps,* as well as undertaking the 
organization of a system of supervision over the preparation 
of the supplies of food for the army. 

All commands at home were instructed by Army Council 
letters of the 8th August, 12th September, and 10th October, 
1914, to pay special attention to the sanitation of camps and 
billets, and, before troops marched into billeting areas, to 
consult the local medical officers of health and sanitary authori- 
ties with a view to obtaining information regarding infectious 
diseases, water supplies, drainage, latrine accommodation, and 
sanitary conditions generally amongst the civil population. 
The Local Government Board at the same time, on the 31st 
August, 1914, issued a circular letter to all medical officers of 
health, setting out the lines of action on which they should 
co-operate with the military sanitary services. Each medical 
officer of health was called upon to place himself in communi- 
cation with the local military authorities, offer his services, and 

* This action applies equally to the Local Government Board of Scotland 
and the Public Health Department of the Local Government Board in Ireland 



192 MEDICAL HISTORY OF THE WAR 

give information and assistance to military sanitary officers 
regarding the water supplies, the disposal of refuse, the drainage 
and conservancy arrangements, and methods of control of 
infectious disease in his district. The sanitary inspectors were 
to help, and a system of inter-notification of infectious disease 
between the civil and military sanitary authorities was estab- 
lished.* Attention was also drawn to the value of anti-typhoid 
inoculation, and the probable need of increased isolation hos- 
pital accommodation, especially for small-pox and enteric fever. 
The Local Government Board also offered the services of its 
medical staff to the medical officers of health of civil sanitary 
areas and arranged for local visits by its medical inspectors 
in connection with the housing of troops.f 

In a subsequent letter to sanitary authorities of the 21st 
October, 1914, the duties of medical officers of health of districts 
in which troops were quartered were still further emphasized 
by the Local Government Board. The extension of water 
mains and sewers, the provision of latrines and baths, hospital 
accommodation for cases of infectious disease, disinfection of 
clothing and blankets, destruction of refuse and special scaveng- 
ing arrangements were regarded as urgent matters which the 
civil sanitary authorities should deal with whenever their 
districts were occupied by troops. The county medical officers 
of health were also called upon to assist by placing at the 
disposal of the military authorities information regarding 
undesirable localities, county water supplies, laboratories and 
isolation hospitals. 

But the direction in which medical officers of health were 
in a position to assist the military authorities most was in 
connection with billeting. The arrangements for billeting 
were in the hands of the Chief Constables and police authorities. 
In the earlier stages of the war there was lack of co-operation 
between them and the sanitary authorities. Neither the civil 
nor the military medical officers were invariably kept informed 
of the movements of troops, and billets were frequently arranged 
without reference to them. The result was that in several 
instances poor class dwellings and insanitary premises were 
often occupied as billets, and at times also the overcrowding 
was considerable. One great difficulty was the insufficiency of 

* Notification of infectious diseases in War Office premises was made 
compulsory in 1916 by the Local Government (Emergency Provisions) Act 
of that year, which suspended Sec. 15 of the Infectious Disease (Notification) 
Act of 1889. 

f Between August, 1914, and March, 1915, twelve medical inspectors of 
the Local Government Board " were almost completely engaged in visiting 
sanitary districts where troops were located." (Supplement to 44th Annual 
Report of L.G.B., p. v.) 



SANITARY ORGANIZATION 193 

latrine accommodation in places where the population of a 
town suddenly expanded to abnormal dimensions. In Lewes, 
for example, upwards of 11,000 recruits arrived almost without 
warning in one day. 

Although the instructions, noted above, required the civil 
sanitary authorities to provide bucket latrines of the camp 
type at suitable sites for troops in billets, these sanitary con- 
structions were not and could not be ready, unless sufficient 
warning had been given. This was specially felt in Durham and 
Northumberland, where troops were billeted in cottages with 
privy middens instead of water-closets. Want of co-operation 
between the police and the sanitary officers was also noticeable 
in connection with water supplies. Empty houses and public 
buildings were often allotted as billets before water had been 
laid on. Again, there was much lack of discrimination in the 
selection of houses. Small houses with large families, houses 
occupied by women only, dirty and dilapidated empty houses, 
and even dairy premises, were allotted by the police authorities. 

The Army Council had drawn the attention of commands, 
in their letter of the 10th October, to the necessity of referring 
to the civil medical officers of health of the districts in which 
troops were to be quartered before the billets were arranged, 
but, notwithstanding the constant efforts of the War Office and 
Local Government Board authorities, many sanitary defects 
continued to exist and led to definite rules as to billeting 
being issued with Army Orders on the 1st December, 1914. 
These required billeting officers to utilize the houses of sub- 
stantial householders first and to avoid the poorer districts ; 
not more than one man to every two rooms, exclusive of kitchen 
and offices, were to be billeted in a dwelling house ; and 
occupants were not to be deprived of bedrooms habitually 
used by them. In large buildings a minimum of 40 superficial 
feet and 400 cubic feet was to be the allowance to each man. 
Field latrines on a scale of four seats per 100 men were 
to be constructed wherever local latrine accommodation was 
insufficient, and all unsuitable and insanitary billets or billets 
infested with insects were to be immediately vacated. 

While the assistance of the Local Government Board 
was freely obtained in dealing with the local sanitary con- 
ditions on the above lines through the medical officers 
of health and their medical inspectors, Colonel W. H. Horrocks, 
the expert in sanitation on the Army Medical Advisory 
Board, was actively engaged in visiting camps and billets, 
and ensuring that practical and, if necessary, drastic 
measures were taken to improve their sanitary condition. 
From the first Colonel Horrocks had been dealing with the 

(1735) 



194 MEDICAL HISTORY OF THE WAR 

selection and laying out of new camps and with various sanitary 
questions connected with the establishment of the territorial 
force general hospitals, but, owing to the complaints which 
were being made regarding the billeting arrangements, he 
was instructed to devote his attention to these and make 
special inspections of them in association with the Local 
Government Board's inspectors. Colonel Sir William Leishman, 
the expert in pathology on the Advisory Medical Board, was 
also instructed to visit the various training centres with a 
view to raising the standard of preventive inoculations and 
establishing laboratories for detecting infective diseases by 
bacteriological methods. 

In September, 1914, enquiries were also made as to the 
extent to which the sanitary officers of the Territorial Force 
R.A.M.C. had been mobilized for duty, and attention was 
drawn to the necessity of inspecting billets and camps occupied 
by refugees and prisoners of war. One of the medical inspectors 
of the Local Government Board was sent to inspect these places, 
and commands at home were instructed to do everything in 
their power to give effect to the desire of the Local Government 
Board to assist in the maintenance of a thorough supervision 
over the sanitary conditions in the country caused by a state 
of war. 

Such, generally, were the earlier efforts in the first months 
of the war to prevent outbreaks of disease amongst the troops. 
The chief difficulties with which the medical services had to 
contend, it will be noted, were brought about by the occupation 
of billets before the sanitary authorities had an opportunity of 
declaring their suitability or the reverse, before ^anitary con- 
structions were ready, and especially before a satisfactory 
system of conservancy and scavenging had been arranged by 
contract. Similar difficulties arose in connection with the 
occupation of camps ; so much so that the medical department 
of the War Office at the beginning of September drew the 
attention of the quartering, works, and finance branches to 
the necessity of taking immediate steps to have the defects, due 
to defective conservancy, remedied. The experience of the 
United States troops in similar camps in Virginia and Florida, 
during the war with Spain in 1898, had not been forgotten ; 
and reports which were reaching the War Office regarding the 
state of the camps in the United Kingdom, and especially the 
prevalence of flies in them, justified the fear that enteric fever, 
which had decimated the American camps, might occur amongst 
the troops in the camps at home under the conditions then 
prevailing. The attention of commands was accordingly 
directed at first to effecting improvements in camp sanitation. 



SANITARY ORGANIZATION 195 

The number of specialist sanitary officers was increased and 
a varying number of men of the London Sanitary Companies 
were allotted to commands and posted to units. 

As regards specialist sanitary officers, the peace organiza- 
tion, as already noted, provided for one only in each command ; 
but with the immense additions to the troops after the declara- 
tion of war it was impossible for him to exercise supervision 
over all. A reorganization of the sanitary arrangements was 
consequently made to meet the requirements of individual 
commands. In the Aldershot Command, where the number 
of troops in the first year of the war averaged some 130,000, 
as compared with 23,000 to 24,000 before the war, there was 
no special 'allotment of sanitary districts under specialist 
sanitary officers, but there was close co-operation between the 
specialist sanitary officer at command headquarters, the 
assistant directors of medical services in the two districts of 
Bramshott and Witley, the officers commanding the military 
hospitals, the officer in charge of the army school of sanitation, 
the laboratory of which was reopened in January, 1915, and 
the medical officers of health of eleven rural or urban sanitary 
districts.* 

In the Eastern Command two specialist sanitary officers were 
employed in August, 1914, one at headquarters and in sanitary 
charge of the area south of the Thames, and the other at 
Colchester for the area north of the Thames. The number of 
troops in the Command rose from some 23,000 to an average 
of 350,000 or more, reaching at one time, in 1915, 600,000. 
For the purpose of sanitary administration, therefore, the 
Command was divided into six districts with sub-districts. 
Apart from the headquarters organization, to which an assistant 
sanitary officer had been appointed on the staff of the specialist 
sanitary officer of the Command, a specialist sanitary officer 
was appointed to each of the six districts, Bedford, Chatham, 
Colchester, Shorncliffe, Woolwich, and Sussex.f Sanitary 
officers were also appointed to the Harwich, Dover, Newhaven, 
and Woolwich garrisons, and to the home counties reserve 
brigade at Tunbridge Wells, as well as to camps at Tring 
(Halton Park), Shorncliffe, Sandwich, Crowborough, Seaford, 
Shoreham, and Croden. In addition to these there were 
specialist sanitary officers on the headquarters of the armies of 

* These were Aldershot, Farnham Urban, Farnham Rural, Farnborough, 
Fleet, Guildford and Woking, Frimley, Hartley Wintney, Alton, Petersfield, 
and Haslemere. Dr. Routley, the Medical Officer of Health for the town of 
Aldershot, was specially in close touch with the Command headquarters 
throughout the whole period of the war. 

f Sussex district had also an assistant sanitary officer. 

1735 O 2 



196 

the Central Force and of the 67th and 68th Divisions, when they 
came under the Eastern Command. Up till 1917, as many as 
five of the specialist sanitary officers in the Command were the 
civil medical officers of health of the districts to which they 
were appointed. In the earlier stages of the war, too, many 
medical officers of health were employed as sanitary officers 
in their own districts,* especially in the areas of the defended 
ports, and in several districts the local civil authorities placed 
the services of one or more of their sanitary inspectors at the 
disposal of the military authorities for the sanitary supervision 
of billets, so that the co-operation between the civil and military 
sanitary authorities in the Eastern Command, and the 
organization of sanitary work generally, became in this way 
' very extensive and complete. 

In the London District conditions differed considerably 
from those in the other commands, and with the exception 
of the sanitary construction and supervision of tented camps 
at Richmond Park and Tadworth and a hutted camp for 
4,000 at Wimbledon in 1915, sanitary organization dealt 
mainly with inspections and sanitary improvements of the 
numerous military, territorial force, and private hospitals 
opened in London. The whole work was supervised from 
Command headquarters, to which Lieut. -Colonel Sir Shirley 
Murphy, formerly Medical Officer of Health to the London 
County Council and an officer of the sanitary service of the 
Territorial Force R.A.M.C., was appointed specialist sanitary 
officer with two assistants. He arranged a meeting with the 
medical officers of health of the 29 London sanitary authorities 
on the 20th August, 1914, when they all agreed to offer their 
services to the D.D.M.S. of the command without remuneration. 
They then met the D.D.M.S. and had definite duties assigned 
to them, including supervision of sanitary conditions of 
billets and encampments, reporting on sanitary defects and 
advising officers commanding units on sanitary matters, 
should an officer of the R.A.M.C. not have been appointed 
already to the unit. In some of the sanitary .districts in 
London this arrangement was continued throughout the war. 
The work of preliminary inspection of premises was also 
greatly helped by the chief inspector! an d his staff in the 
department of the London County Medical Officer of Health. 

In the Northern Command, the normal garrison of which 
increased from some 6,000 regular and 6,000 reserve troops 
to a floating strength which varied between 200,000 and 

* They were paid as civil practitioners, 
f Mr. H. A. Jury. 



SANITARY ORGANIZATION 197 

400,000, the sanitary organization followed on much the same 
lines as in the Eastern Command. In addition to increasing 
the accommodation by constructing huts in barracks for this 
vast increase of troops, large camps were formed at Cannock 
Chase,* Clipstone,f Grantham,J Ripon, and Catterick,|| as 
well as various smaller camps capable of holding one or two 
battalions each. Sanitary officers were appointed to each 
of these and also to the coast defence garrisons on the Tyne, 
Tees, Humber, Yorkshire, and Lincolnshire defences. The 
number of sanitary officers in the Command was thus increased 
from the one specialist at Command headquarters to fifteen. 

In the Southern Command the employment of medical 
officers of health as the military specialist sanitary officers 
of sanitary districts was well exemplified, the medical officers 
of health for Hampshire, for Weymouth, the City of Bristol, 
Falmouth, and the Isle of Wight, becoming respectively the 
specialist sanitary officers for the Hampshire ; Weymouth ; 
Bristol, including Somerset and Gloucester ; Falmouth, including 
West Cornwall ; and the Isle of Wight military sanitary areas. 
Other sanitary areas with special sanitary officers to each were 
the Plymouth area, including Devonshire and part of Cornwall ; 
two areas in Wiltshire, one for the Wyley Valley and the 
other for Salisbury Plain ; Birmingham, including the counties 
of Warwick and Worcester ; the Dorset training area ; and 
the Oxford area, including Berkshire. 

In the Western Command, sanitary organization, like 
hospital organization, was very much more centralized than 
in other commands. There was no division into definite 
sanitary areas until 1918 ; the whole of the sanitary work 
being supervised by the specialist sanitary officer at Command 
headquarters, who was appointed at the beginning of September, 
1914, and remained at headquarters in Chester until the end 
of the war. The officer selected for this duty was the Medical 
Officer of Health for Chester Major D. Rennett who, like 
Sir Shirley Murphy in the London District, was one of the 
sanitary officers of the Territorial Force R.A.M.C. During 
1917 and 1918 an assistant sanitary officer was appointed to 
help him. The local supervision of sanitary measures was 
entrusted to an officer on the staff of one of the local 
military hospitals, who was responsible to his commanding 
officer or to the senior medical officer of the garrison for 

* Brocton Camp for 20,000, Rugeley Camp for 21,000. 

f For 20,000. 

+ Harrowby and Belton Park Camps for 7,000 each. 

For 28,000. 

|| Hipswell and Scotton Camps for 42,000. 



198 MEDICAL HISTORY OF THE WAR 

carrying out sanitary inspections and seeing that all suitable 
sanitary measures were being enforced. From 1918 onwards 
this practice ceased. The Command was then mapped out 
into nine sanitary areas: No. 1 sanitary area included South 
Wales with headquarters at Cardiff ; No. 2 and No. 3 sanitary 
areas included Mid- Wales with headquarters at Frees Heath 
and Oswestry ; No. 4 area was North Wales with headquarters 
at Kinmel Park ; No. 5 was the Chester area ; No. 6 the 
Mersey defences ; No. 7 Manchester with headquarters at 
Heaton Park ; No. 8 Blackpool, and No. 9 Cumberland and 
Westmorland. A specialist sanitary officer was appointed 
to each with the exception of Nos. 2 and 3 which had one 
sanitary officer for both ; and No. 5 and No. 9, which the 
Command specialist sanitary officer himself supervised. 

In the Scottish Command for a short period after mobiliza- 
tion, sanitary supervision in the two territorial divisions was 
carried out by the specialist sanitary officers of the division, 
namely Lieut.-Colonel A. K. Chalmers, M.O.H., Glasgow, for the 
Lowland Division, and Lieut.-Colonel T. F. Dewar, one of the 
medical inspectors of the L.G.B. of Scotland, for the Highland 
Division ; elsewhere by the medical officers of units. Soon 
after mobilization the Highland Division with its sanitary 
officer left the Command. The sanitary officer of the Lowland 
Division was demobilized at the request of his local authority, 
and sanitary supervision then devolved upon the D.A.D.M.S. 
at Command headquarters. At the beginning of December, 
1914, a regular officer was appointed specialist sanitary officer 
for the Command, and, later, an assistant sanitary officer was 
also appointed. Sanitary control was centralized at Command 
headquarters where both these officers were stationed, but 
throughout the command wherever troops were concentrated 
medical areas were formed and the senior medical officer of 
each appointed one of his officers to supervise and control local 
sanitary measures. The number of areas varied from time 
to time and depended on the distribution of troops. From 
the beginning of 1917 the Command was divided into two 
districts Eastern and Western to each of which a specialist 
sanitary officer was appointed, the sanitary appointments at 
Command headquarters being abolished. The system of 
medical areas was, however, continued in both these districts. 
The Local Government Board of Scotland kept in close touch 
with the specialist sanitary officer of the Command through 
one of its medical inspectors ; the senior medical officers of 
areas maintained close touch with the local medical officers 
of health ; and civilian sanitary inspectors both in town and 
country exercised systematic supervision over billets, public 



SANITARY ORGANIZATION 199 

halls, schools and other buildings occupied by troops. Further, 
in many cases a civil medical officer of health was appointed 
as civil medical practitioner in charge of troops. 

The Irish Command had a sanitary organization somewhat 
similar to that in Scotland, the specialist sanitar}' officer in 
the Command and local officers in charge of camps, garrisons 
and units keeping in touch with the Public Health Department 
of the Local Government Board and medical officers of health. 
A specialist sanitary officer was appointed to each of the 
A.D.M.S. districts of the Command, but the tenure of his 
appointment was insecure and the post was often vacant. 

As regards subordinate personnel for sanitary work in the 
home commands, the regimental sanitary detachments were 
far from efficient, both in training and in numbers, in many 
of the new units and territorial force units on mobilization, 
owing partly to frequent changes of personnel and partly 
to the want of experience or indifference of their commanding 
officers as regards sanitary details. It was seldom that the 
normal sanitary detachment of one N.C.O. and eight men 
was allowed in a battalion. This was especially so in the case 
of units of the Royal Air Force. Consequently, those individual 
officers and men of the 1st and 2nd London Sanitary Companies, 
who were posted to commands, were distributed to various 
sanitary districts and regimental units for duties of a super- 
visory character. At first the men worked under their own 
officers, but as their duties necessitated their being attached 
for rations and discipline to units in various localities, the 
control of their own officers was more nominal than real and 
their immediate commanding officer became the medical 
officer of the unit to which they were attached. Later on, 
both officers and men were posted for duty under the specialist 
sanitary officer of the area and took charge of all schemes of 
sanitation within the command, especially those schemes 
which dealt with incineration of refuse and excreta. Their 
duties were, however, always of a supervisory character, the 
actual work being carried out by contractors' personnel or 
personnel of labour companies. 

The establishment of London Sanitary Companies in each 
command varied. In the Southern and Northern Commands 
for example, an establishment of 100 was authorized, con- 
sisting of eight warrant or non-commissioned officers and 
92 privates. The number of officers was not fixed and varied 
within wide limits. Amongst those who enlisted in the com- 
panies before the Military Service Act was passed were many 
men with professional knowledge as engineers, architects 
and chemists, or were men who in civil life were 



200 MEDICAL HISTORY OF THE WAR 

the managers of extensive commercial enterprises and 
of recognized administrative ability. Others were skilled 
tradesmen, mechanics, plumbers, and bricklayers. After the 
Act was passed only men of low physical category were 
appointed to the London Sanitary Companies for home service. 
In the earlier stages of the war, when the actual number of 
men in the companies was small, the majority had been 
drafted overseas to form the new sanitary sections with divisions. 
The London Sanitary Companies not only carried out 
all the duties allotted to them, but initiated practical reforms 
in sanitary matters. Technical difficulties were overcome,, 
sanitary apparatus and appliances were evolved from scrap 
heaps, labour gangs were organized, plans were drawn, and 
schemes materialized often from a mere suggestion made to 
them ; so much so that from the earliest days the London. 
Sanitary Companies may fairly claim to have played one of 
the most important parts in connection with sanitation during 
the war both in the United Kingdom and overseas. 

The work carried out by the sanitary organization at home 
was of a very varied character and embraced most of the 
sanitary requirements of a civil population. Amongst the 
earliest problems which had to be faced was that of the 
detection and isolation of infectious diseases. The fear of 
outbreaks of enteric fever during the autumn of 1914, when 
troops were being crowded into camps before camps were ready 
in a sanitary sense to receive them, was fortunately not 
realized ; but when troops were moved into billets from the 
tented camps for the winter, another disease, cerebro-spinal 
meningitis, became epidemic and continued during the war 
with greater or less prevalence, especially amongst the 
Canadian and other Dominion contingents. It was prevalent 
amongst the civil population as well as amongst the troops, 
and showed a marked recrudescence in 1917. In fact, the only 
important epidemic diseases in the home commands, which 
called for special measures, were the outbreak of cerebro-spinal 
meningitis in the winter of 1914-15 and subsequent years, 
and a widespread and fatal outbreak of influenza in the winter 
of 1918-19. Bacteriological centres, under bacteriological 
specialists, were established in all commands ; inhaling 
chambers were constructed in camps for nasopharyngeal 
disinfection of whole battalions ; and sample swabbings for 
detection of carriers and of contacts became a routine practice, 
carriers being isolated until the swabbings were negative.* 

* The exact definition of a " contact " was not formulated. It generally 
referred to any one sleeping in the same room, hut, or tent with a man who- 
developed infectious disease, but was variously interpreted according to 
circumstances. 



SANITARY ORGANIZATION 201 

Free ventilation, increase of lateral sleeping space for each 
man in barracks and huts, and prevention of overcrowding 
generally were measures specially required in connection both 
with the cerebro-spinal fever and with the influenza 
epidemics. The huts constructed for the Royal Air Force 
in some localities at any rate, notably in the Southern 
command, were not well adapted for free ventilation. They 
were of a type different from those adopted for other troops, 
and were not so well constructed from a sanitary point of 
view. The military sanitary officers were made responsible 
for the sanitation of aerodromes, and considerable trouble 
was caused by the difficulties encountered by them in 
maintaining a satisfactory standard of sanitation in them, 
especially in combating the epidemic of influenza. In fact, 
the system of dual control under which disciplinary measures 
connected with sanitation had to be adopted by commanding 
officers of Royal Air Force units while the responsibility for 
the sanitation of their camps rested with the Army Medical 
Administration did not prove satisfactory. 

Scabies and verminous conditions called for routine disin- 
fection of clothing and blankets. The rapidity of mobilization- 
and the introduction into camps of large numbers of recruits 
might well have created a somewhat extensive incidence of 
these conditions at the beginning of the war, but the prevalence 
of vermin was never high at any time or place at home. The 
men were frequently inspected by medical officers and suspected 
cases were at once removed for treatment. In some commands, 
notably in the Eastern Command, special scabies treatment 
centres were established. By the summer of 1918, 28 had 
been opened in that Command. They were organized not 
only for treatment, but also for disinfestation and issue of 
clean clothing. Excessive sulphur treatment with resulting 
dermatitis was the chief difficulty in dealing with scabies, so- 
much so that an Army Council Instruction on the subject 
was issued early in 1918 standardizing the treatment and 
insisting on definite preventive measures and skin inspections 
being carried out. 

The means of disinfection were various. At large stations 
permanent steam pressure disinfectors were established, at 
others portable Thresh disinfectors and Clayton apparatus 
for disinfection by sulphur dioxide gas were used for the 
routine disinfection of clothing and blankets. 

But the diseases which probably caused the greatest amount 
of constant inefficiency in the home commands and which 
called for special preventive measures were venereal diseases. 
The incidence of these was very high amongst troops 



202 MEDICAL HISTORY OF THE WAR 

of the Dominion contingents, in somewhat marked contrast 
with their incidence amongst other troops. In the Southern 
Command, for example, where the greater number of the 
Australian and New Zealand troops were stationed, the annual 
admission-rate was estimated to be as high as 128 and 130 
per 1,000 of strength respectively as compared with 24 per 1,000 
amongst other British troops in the Command. The inefficiency 
may be estimated from the average stay of each case in hospital, 
which was from five to seven weeks. Efforts were consequently 
made to prevent venereal disease by the establishment through- 
out the home commands of self-disinfection centres, called 
" early treatment centres," where men were provided with the 
means of disinfection after exposure to risk. Medical officers 
were appointed in the later stages of the war as inspectors 
of these early treatment centres. The duties were not only 
to see that the centres were properly maintained and used but 
also to educate the men by lectures on the danger of venereal 
diseases and by demonstrations on the methods of personal 
disinfection. The success of these centres in preventing vene- 
real disease is a matter of controversy. At first they were 
placed in latrines, where the lighting was bad and without an 
orderly in attendance ; nor was it possible, by recording the 
names of those who made use of them to trace the after-results. 
But the difference in the incidence of venereal diseases amongst 
the Australian and New Zealand troops and other British 
troops in the United Kingdom is remarkable from the fact that 
preventive measures were enforced amongst the Dominion 
troops and not amongst the British. In the American camps, 
too, personal disinfection after exposure was also rigidly en- 
forced, and in the early treatment centres of the Australian, 
New Zealand, and American units an orderly was always in 
attendance. Yet they suffered from venereal disease in far 
greater proportion than the British troops. It is little wonder, 
therefore, that sanitary organization for the prevention of 
these diseases has become highly controversial, for the value 
of immediate disinfection for the prevention of infectious dis- 
eases of this nature can scarcely be disputed as an abstract 
principle, however it may have failed in practice. 

The prevention of disease by vaccination and prophylactic 
inoculations was very thoroughly carried out in the home 
commands. Vaccination against small-pox was enforced in 
accordance with the conditions under which recruits attested ; 
but in January, 1916, the Army Council decided that men who 
declined vaccination might be enlisted, and in September of 
the same year permitted unvaccinated men to proceed as drafts 
to expeditionary forces. This relaxation in the regulations 



SANITARY ORGANIZATION 203 

governing vaccination had a disastrous effect amongst troops 
in Mesopotamia. Small-pox was endemic amongst the Arabs, 
resulting in a serious and fatal outbreak of small-pox 
amongst those British troops in contact with them who had not 
been vaccinated. Inoculation against enteric fever was not 
compulsory, but education of the troops with regard to it had 
excellent results ; results, which may justly be described as 
unparalleled in war. During the influenza epidemic and during 
a sharp and serious outbreak of purulent bronchitis, probably 
of influenzal origin, amongst New Zealand troops in February, 
1918, vaccines were used as prophylactics. The vaccine used 
by the New Zealand troops was an autogenous, mixed catarrhal 
vaccine, but during the influenza epidemic the War Office 
issued a supply of somewhat differently constituted mixed 
vaccine, prepared at the Royal Army Medical College. These 
vaccines were not, however, universally used in the United 
Kingdom. 

When convalescents from malaria began to arrive in England 
from Macedonia and elsewhere in large numbers, there was 
some anxiety regarding infection of the civil community in 
localities where mosquitoes were likely to breed. A reconnais- 
sance of mosquito infested areas in all commands in the United 
Kingdom was consequently made, with a view to the suppres- 
sion of mosquito breeding and preventing the concentration 
of malarial patients in areas where mosquitoes existed. In 
connection with these measures an entomological laboratory 
was established at Sandwich early in 1919. 

Amongst other sanitary work of the specialist sanitary officers, 
the arrangements for warming and ventilating huts, for ablu- 
tion, for drying wet clothes, for supervision of canteens, kitchens, 
and messing generally, for disposal of waste products, methods 
of incinerating refuse and night-soil, the prevention of flies, 
and the destruction of rats, came under their routine adminis- 
tration and supervision. 

The establishment of destructors or incinerators, and the 
organization and supervision required to make the disposal of 
latrine contents by these methods effective, were the special 
concern of officers and men of the London Sanitary Com- 
panies. In January, 1916, the Army Council decided that 
incineration of night-soil should be the rule in hutment camps 
where water-borne systems of sewage were not in existence. 
Sanitary establishments were to be formed for the purpose in 
each camp and placed under the control of the sanitary officers, 
who were made responsible for the intelligent working of the 
system and had authority to deal direct with command head- 
quarters. At first commercially manufactured destructors, 



204 MEDICAL HISTORY OF THE WAR 

such as the Horsfall and Meldrum patterns, were provided, 
and an establishment of two men for loading and firing and 
for cleaning receptacles, with additional labour for removing 
receptacles from latrines, under a non-commissioned officer, 
was authorized for each destructor for a unit of 1,000 men, but 
for the larger destructors for camps of several units the number 
of destructor squads was increased in proportion. The men 
employed were specially trained for the purpose and were to 
be men fit for home service only.* After September, 1916, 
inexpensive improvised types of incinerators such as were being 
used in the field, and of the type known as the " Bailleul " 
incinerator made from empty biscuit tins and clay, were 
ordered by an Army Council Instruction to be constructed 
in future in preference to the more permanent and expensive 
Horsfall or similar destructors. 

Progress, however, in organizing incineration and providing 
destructors was as a rule slow, and there was occasionally some 
local opposition to the system, but sufficient experience had 
been gained during 1916 to enable the sanitary authorities to 
estimate more precisely the establishment, equipment and trans- 
port required for different classes of destructors. The details 
of these were issued in an Army Council Instruction of January, 
1917. Unit destructors of all types for 1,000 men were allotted 
a squad of four men each, while larger destructors for 4,000 to 
6,000 men, or 6,000 to 8,000 men were allotted one non-com- 
missioned officer and fourteen or sixteen men. The specialist 
sanitary officer at command headquarters was then made 
responsible for the erection of " Bailleul " destructors, and 
for the organization of all schemes of incineration in the 
command.f Local opposition to incineration schemes was 
thus avoided. 

Some figures and experiences of incineration, obtained from 
the Southern Command, are of value. At the time of the 
Armistice the night soil of 144,264 men was being incinerated 
in this Command, amounting to a daily average of 51 tons 
with an average daily consumption of 8 tons of fuel.J The 
personnel employed was 576 labour men and members of 
the London Sanitary Companies. On demobilization of the 
Labour Corps and the consequent impossibility of obtaining 
military labour, the incineration of night-soil was carried out 
by contract, but this proved so unsatisfactory that the specialist 
sanitary officer was authorized to engage civilian labour for 

* Category Cii, A.C.I, of the 24th June, 1916. 

t In the Eastern Command some 400 incinerators were erected, of which 

200 were of the " Bailleul" type, 125 were Horsfalls, and 75 were other types. 

J The fuel authorized by A.C.I, of January, 1917, would amount to 11 tons. 



SANITARY ORGANIZATION 205 

the purpose, and thus continued, under his direct supervision, 
the system of incineration which was carried out before demobi- 
lization. This arrangement, both from an economic and 
sanitary point of view, proved much superior to the contract 
system. Various other methods were employed for disposal of 
night-soil, but they were more or less of an experimental 
character and had no special bearing on sanitary organization 
in commands at home ; but in the early days of the war the 
removal and disposal of night-soil were carried out by con- 
tractors. Both economically and sanitarily the contract system 
failed, and it was in fact due to this, as well as to the success 
of incineration in the armies in the field, that disposal by 
incineration was introduced into the home commands at the 
beginning of 1916.* 

Sanitary salvage was also a special feature of the sanitary 
services during the war in the home commands ; and the 
collection and disposal of fats, paper, tins, or other waste 
material of commercial value became part of an organized 
system, which resulted not only in profit but in cleaner camps. 

Reference has been made to the co-operation of the Local 
Government Board in supervising the preparation of supplies 
of food for the army. Under the direction of its Chief Inspector 
of Foods, civilian medical officers of health kept the preparation 
of army foods under close observation locally with a view to 
ensuring only wholesome materials being used and prepared 
under good hygienic conditions. The assistance which local 
public health authorities generally, under the guidance of the 
Local Government Board, had rendered since the outbreak of 
the war was acknowledged by the Army Council in a letter 
to the Secretary of the Local Government Board of the 25th 
March, 1915, referring in special terms to the valuable services 
which had been given by medical officers of health, sanitary 
inspectors, and other officials of the local authorities in 
co-operating with the military sanitary services. 

Finally, under sanitary organization in the home commands, 
the importance of special schools of instruction for training 
R.A.M.C. personnel for sanitary duties, assumed considerable 
prominence in the later stages of the war. It will be 
remembered that the army school of sanitation at Aldershot 
was closed on mobilization. It was reopened, but for 
laboratory work only, in January, 1915, although from time 
to time afterwards courses in sanitation were held for officers 



* In the Southern Command contractors at first demanded 6d. per bucket, 
but when they came into competition with the incineration system, Contracts 
were tendered at less than Id. per bucket. 



206 MEDICAL HISTORY OF THE WAR 

and men ; but no definite organization of schools of sanitation 
was authorized for commands generally until much later. The 
officers and men of the London Sanitary Companies of the 
Territorial Force R.A.M.C. were trained at their depot at 
the Duke of York's School in London until their removal to 
Blackpool, and the D.D.sM.S. of some of the commands, on 
their own initiative, commenced a series of lectures on practical 
sanitation and hygiene, mainly for combatant officers. In 
the Eastern Command, for example, courses of lectures were 
given from August, 1917, in the Royal Sanitary Institute 
buildings, with demonstrations at the London Sanitary 
Companies' depot. Each course lasted three days and consisted 
of six lectures on hygiene, water supply, food, insect-borne 
diseases, and tropical hygiene, with two practical demonstrations. 
They were given by the Command sanitary officer and dis- 
tinguished scientists who offered their services. Fifteen courses 
of lectures of this nature, attended by 955 officers, were given 
up to the 8th November, 1918. In the Scottish Command 
three-day courses of instruction in military hygiene were also 
given. They were held at Glasgow University, and twenty 
medical officers and one hundred combatant officers, including 
officers in charge of messing, attended each course. The lectures 
comprised the principles of prevention of disease in war, dietetics, 
entomology, camp sanitation, and tropical sanitation, with 
demonstrations. The lecturers were the professors of Public 
Health, Physiology, and Zoology of the University, the Command 
specialist sanitary officer, and the consultant in malaria. Similar 
courses were arranged by the Command sanitary officer in the 
Southern Command. But the first definitely authorized school of 
army sanitation during the war, as distinct from the pre-war 
school at Aldershot, was at Leeds in the Northern Command. 
It was established in the grounds of the 2nd Northern General 
Hospital, originally with a view to instructing in field sanitation 
those officers of the U.S. Army who were undertaking service 
with the British. Captain Daukes, of the sanitary service of the 
Territorial Force R.A.M.C., who had much experience in France 
in command of a sanitary section, was responsible for its 
organization. Large numbers of British and American officers 
attended the courses of instruction in it. But when Blackpool 
became the training centre for the R.A.M.C. much useful train- 
ing in sanitation was carried out as part of the ordinary R.A.M.C. 
training course there, and subsequently a School of Hygiene 
was established which took the place of the training school of 
the London Sanitary Companies when the latter were trans- 
ferred to Blackpool in 1918, as well as providing advanced 
instruction for officers and sanitary specialists, especially in 



SANITARY ORGANIZATION 207 

tropical medicine and hygiene. Schemes for the establishment 
of schools for sanitary instruction in each command, following 
the general organization adopted in the establishment of the 
Leeds school, were under consideration at the time of the 
Armistice, but as the instructions for these were not issued 
before the war had come to an end, they played no part 
in the sanitary organization of the war. Like the general 
organization of sanitary services under a Director of Hygiene 
at the War Office, they were an after-product. 



CHAPTER XI 

ORGANIZATION OF VOLUNTARY AID 

VOLUNTARY aid, since the campaign in Italy of 1858, has 
played a prominent part in time of war in connection with 
the care and comfort of the sick and wounded. It has been a 
popular tradition that the regular medical services of an army, 
either from inadequacy of personnel and equipment, or from 
lack of elasticity and sympathy in administration, are incapable 
of giving all the care to which sick and wounded are entitled. 
But whatever may have been the original causes of this popular 
tradition it is essential to recognize that it is through 
voluntary aid organizations more than through official 
channels that the sympathy of the people, of the women of 
the country, and of those who from various causes are unable 
to take a more active part in a nation's struggle finds 
expression. It thus becomes that element in the medical 
services of an army during war which appeals most to the 
popular imagination and obtains the greatest support in the 
public press. 

But without organization and responsible control and 
guidance in time of war voluntary aid is apt to be wasteful, 
to embarrass military administration, and thus to become a 
forcible example of misdirected effort. Further, it is liable to 
be used by some as a means of gaining notoriety or social 
advantage, and it not infrequently happens that individuals 
engaged in espionage endeavour to obtain admission into the 
ranks of voluntary organizations because of the opportunities 
afforded for ascertaining facts regarding movements of troops 
and casualties, and because of the freedom they experience 
from control in the belief that they are engaged in humanitarian 
work. This at any rate has been the recorded experience of 
previous Continental wars. 

It is, however, a difficult and delicate matter to control offici- 
ally those organizations, local committees and private individuals 
who are genuinely eager to help whenever war is declared. 
The Field Service Regulations had thrown the task of doing 
so on the British Red Cross Society. Its duties, in accordance 
with the regulations, were to consider all offers of assistance in 
aid of the sick and wounded and communicate them to the 
Army Council if they were likely to be of practical value. 

208 



ORGANIZATION OF VOLUNTARY AID 209 

The offers of assistance were regarded as falling under two 
classes : first, offers of assistance from those willing to provide 
suitable gifts and receive convalescents ; and secondly, those 
willing to provide complete medical units. The British Red 
Cross Society, according to the regulations, was to organize 
a central depot for the collection of gifts from voluntary 
sources, and the name and address of the central depot was to 
be published in the public press on the outbreak of war. As 
regards voluntary medical units, they were obliged by the 
Geneva Convention to conform with the constitution, personnel, 
and equipment of corresponding medical units in the army ; 
and, if accepted by the Army Council, were to come under the 
orders of the military authorities and be incorporated with the 
medical units in the army in whatever manner and for whatever 
purposes the Commander-in-Chief might determine. Their 
employment, however, with field units or formations was not 
permitted except under special authority, and no one who was 
not a British subject was permitted to be employed in them. 
In all cases the Army Council reserved its right to accept or 
reject any or all offers of voluntary aid in time of war ; and 
such as might be accepted were subject to the authority of the 
Commander-in-Chief, from whatever source they might come. 

These regulations failed in their intention in the early 
stages of the war, chiefly because the constitution of the 
British Red Cross Society in peace did not provide for 
guidance by and association with the responsible military 
and army medical authorities, or for co-operation with other 
voluntary aid organizations; and it had no suitable premises 
available at once for the organization of a central depot for 
the collection and distribution of gifts and comforts to the 
sick and wounded. 

The situation may be explained best by a brief retrospect 
of the origin of Voluntary Red Cross Organizations in Great 
Britain. 

A National Society for Aid to Sick and Wounded in War 
had been formed, mainly through the influence of certain 
members of the Order of St. John of Jerusalem, at the time of 
the Franco-German War of 1870-71 ; but it only existed in 
after years as the trustee of the surplus funds which had 
then been collected and which were utilized, along with other 
contributions, in affording a measure of voluntary aid to the 
sick and wounded in various subsequent wars. Although it 
was, therefore, not organized in any way as an auxiliary on 
which the Army Medical Service could depend, it represented 
an element out of which a National Red Cross Society might 
be formed under suitable organization and association with 

(1735) P 



210 MEDICAL HISTORY OF THE WAR 

military administration. The need of suitable organization 
of this kind was brought forcibly to the notice of the War 
Office by its delegate to the 6th International Conference of 
Red Cross Societies in Vienna in 1897.* In reporting on the 
importance and excellence of the voluntary aid organizations of 
other countries, he pointed out how the want of similar organiz- 
ation in Great Britain would lead to serious embarrassment 
and confusion should Great Britain be involved at any time in 
a great war. 

Lord Lansdowne was then Secretary of State for War, and, 
at his direction a conference was held at the War Office on 
8th July, 1898, with the representatives of voluntary aid 
organizations for the purpose of considering the organization 
of voluntary aid in time of peace on the lines of the Red Cross 
Societies of other countries. The conference agreed to the 
formation of a permanent Central British Red Cross Committee 
which was approved by the Secretary of State for War in 
January, 1899, and the fact was made known through the 
public press in the following April. The Committee, as 
officially recognized, consisted of representatives of the 
St. John Ambulance Association, the National Society for Aid 
to Sick and Wounded in War, the St. Andrew's Ambulance 
Association, Princess Christian's Army Nursing Service Reserve, 
and the Directorates of Mobilization and Medical Services at 
the War Office. Voluntary aid organization had thus come 
into being a few months before the outbreak of the South 
African War. The outbreak of that war, however, prevented 
progress being made in the development of the schemes which 
the committee was maturing for the peace organization of 
voluntary aid ; but the value of the association of the 
voluntary societies with the War Office authorities was so 
obvious that steps were taken after the war to strengthen the 
constitution of the Central British Red Cross Committee and 
to extend its work so as to bring the general principles and 
requirements of Red Cross organization more in touch with 
the country at large and with the British Dominions and 
Colonies. For this purpose a carefully organized scheme was 
drawn up by a sub-committee of the Central British Red Cross 
Committeef in 1904. The Committee was renamed the 
Central British Red Cross Council. Its functions included the 
general control and organization of voluntary aid, and it was 
to be the medium of official communication between the 
War Office and voluntary aid societies, and with Red Cross 

* Surgeon-Major W. G. Macpherson. 

f The late Sir John Furley, Sir A. Keogh (then D.D.G., A.M.S.), the late 
Major T. McCulloch (D.A.D.G., A.M.S.), Hon. Secretary of the Committee. 



ORGANIZATION OF VOLUNTARY AID 211 

organizations abroad. Its constitution was similar to that 
of the original Central Committee. The National Society for 
Aid to Sick and Wounded in War was to be represented by 
three members, the St. John Ambulance Association, the 
Army Nursing Reserve, the St. Andrew's Ambulance Associa- 
tion, and the Admiralty by two members each ; and the 
Secretary of State for War by the Deputy Director-General 
of the Army Medical Service, the Officer in charge of Mobiliza- 
tion Services, and the Officer in charge of Medical Mobilization 
Services. The National Society for Aid to Sick and Wounded 
in War was to retain its designation, but its constitution was 
to be revised, and its committee strengthened to enable it 
more fully to carry out the functions of representing the 
popular side of voluntary aid, of organizing local committees 
of voluntary aid as branches of the society in districts and 
towns, and of collecting and holding funds. 

This scheme was officially adopted and published in 1904, 
and if the Central British Red Cross Council had continued its 
existence from then onwards there would have been ready 
when war was declared an organized authority, representing 
all the elements of voluntary aid, with power to co-operate 
with, guide, and, where necessary, restrain voluntary efforts at 
the time when popular guidance and restraint were needed most. 

Unfortunately the Central British Red Cross Council, 
although officially recognized, was immediately dissolved 
before it had commenced exercising its functions. Those 
who had at the time the direction of the National Society for 
Aid to Sick and Wounded in War, and who held the funds 
without which a central organization of voluntary aid in time 
of peace would not be possible, deemed it wiser to form the 
Society into a British Red Cross Society, which should be 
entirely independent of the War Office and have no associa- 
tion on a central council with official representatives of respon- 
sible military authorities or other voluntary organizations. 

As was proved by subsequent events, a cardinal error had been 
made, and could only have been made by a misunderstanding 
of the restrictions under which the emblem and distinctive 
sign of the Red Cross could be used by any voluntary society. 
Both designation and emblem are the distinctive sign of the 
medical services of armies, and no person or society is at liberty 
to use them under the articles of the Geneva Convention, either 
in time of peace or in war, unless employed in medical units 
and establishments of armies and subject to military law and 
regulations. In other words, the army medical services, 
strictly speaking, are the Red Cross, and the emblems seen 

(1735) P2 



212 MEDICAL HISTORY OF THE WAR 

on ambulance wagons, motor ambulance cars, ambulance trains, 
hospital ships, and other material, indicate that they are the 
property of the State and the transport and equipment of its 
military medical services.* 

It is necessary to make the significance of this clear, as both 
in the public press and in other writings during and after the 
war the erroneous impression has been created that where 
mention was made of the work of the Red Cross in the field 
it referred to the work of the Red Cross societies and not of 
the military medical services, and when ambulance trains, 
ambulance cars and other material were seen marked with 
a Red Cross on a white ground, that they were contributions 
from voluntary organizations under the Red Cross Society, 
whereas in the majority of cases they were the ordinary equip- 
ment of army medical units... The importance, therefore, of 
close association at all times in peace and war between the 
army medical authorities and societies who had been per- 
mitted to use the term " Red Cross " underlay the whole spirit 
and intention of the Geneva Convention as revised in 1906,f and 
was a prominent feature in the organization of voluntary aid 
in other belligerent countries which took part in the war that 
broke out in 1914. 

It was, however, under different conditions that the British 
Red Cross Society came into existence and commenced taking 
a more active part in peace organization of voluntary aid to 
sick and wounded than the National Aid Society had pre- 
viously regarded as its function. Its attitude of independence 
from War Office guidance or control and its severance from 
association on a central council with other important voluntary 
organizations created a situation which could only be regarded 
with misgiving. J 

* Article 10, Geneva Convention of 6th July, 1906 : " The personnel of 
voluntary aid societies, duly recognized and authorized by their Government, 
who may be employed in the medical units and establishments of armies, is 
placed on the same footing as the personnel referred to in the preceding Article, 
provided always that the first-mentioned personnel shall be subject to military 
law and regulations." 

Article 18, " The heraldic emblem of the red cross on a white ground . . . 
is retained as the emblem and distinctive sign of the medical service of armies." 

Article 23, " The emblem of the red cross on a white ground and the words 
' Red Cross ' or ' Geneva Cross ' shall not be used either in time of peace or 
in time of war, except to protect or to indicate the medical units and establish- 
ments and the personnel and material protected by the Convention." 

fin the original Convention of 1864, voluntary organizations had no 
privileges in war nor were they recognized as having any claim to the 
designation or emblem of the Red Cross. 

J These remarks do not, of course, apply to the organization of voluntary 
aid detachments which were initiated by the War Office to form an integral 
part of the Territorial Force, and which were controlled and co-ordinated by 
the Territorial Force County Associations. 



ORGANIZATION OF VOLUNTARY AID 213 

At first the lack of co-ordinated effort on the part of voluntary 
organizations led to confusion and embarrassment, and much 
of the time of the administrative medical services and other 
responsible authorities at the War Office was occupied at the 
most critical period of the war in endeavouring to satisfy the 
conflicting interests of the various voluntary bodies, which the 
state of war had roused into activity. On one side the British 
Red Cross Society found it difficult to carry out its duties under 
the Field Service Regulations without War Office guidance ; 
and on the other hand the War Office, without association with 
voluntary organizations, had not full or adequate knowledge 
of what they were organizing or capable of carrying out. 

In order, therefore, to establish some form of co-ordination 
and guide the voluntary organizations into channels where 
their activities might be most useful, the Army Council, shortly 
after war was declared, invited representatives of the British 
Red Cross Society, the Order of St. John of Jerusalem, the 
St. Andrew's Ambulance Association, the Soldiers' and Sailors' 
Help Society, and the Admiralty, to meet at the War Office 
weekly under the chairmanship of the Deputy-Director General 
of Medical Services, and discuss the general situation. The first 
meeting was held on the 29th August, 1914,* when Mr. Makins 
and Sir Rowland Bailey, representing the British Red Cross 
Society, gave an account of the work of the Society up to date. 
A medical unit under Dr. James Wyatt had been sent to 
Brussels during the previous week ; and a small rest station 
party was being sent to Boulogne that day. A party of ten 
surgeons, ten dressers, and twenty nurses was being organized 
to proceed to France to work under the Chief Commissioner of 
the Red Cross Society theref ; and arrangements were being 
made to open a store at Rouen or Havre for supplying comforts 
and distributing gifts to sick and wounded. The Society was 
classifying voluntary hospitals in England, and had offered 
a fully equipped hospital of 500 beds to be established as 
a section of the Royal Victoria Hospital, Netley. It was also 
receiving offers of motor cars for ambulance purposes. Both 
the Order of St. John and the St. Andrew's Ambulance Associa- 
tion were organizing depots for reception and distribution of 
gifts, in addition to providing the personnel for the Home 

* This committee continued to meet weekly until August, 1915, when 
meetings were held monthly until the end of the year. They were then 
discontinued. In a letter expressing regret at the committee ceasing to 
exist, the representative of the St. Andrew's Ambulance Association stated 
that he had found the committee of much value to his association, as it gave 
them an opportunity of ventilating a good many matters. 

t Sir Alfred Keogh, who had gone to Brussels on the 18th August and from 
there to Paris. 



214 MEDICAL HISTORY OF THE WAR 

Hospital Reserve. The Soldiers' and Sailors' Help Society was 
organizing convalescent homes, as already described.* 

While this attempt at bringing voluntary organizations 
together was being made by the Army Council, the Chairman 
of the British Red Cross Society, Lord Rothschild, on behalf 
of his Executive Committee, made a strong and urgent appeal 
to the War Office on the 19th August, 1914, asking Lord 
Kitchener to appoint a highly placed representative of the 
War Office to the Standing Committee of the Society in order 
that the responsible Government department might be in touch 
with the difficulties experienced by the Society owing to its 
not having the power to control the irresponsible offers of 
assistance, appeals for money, and use of the Red Cross name 
arid emblems. Lord Rothschild in his letter stated that unless 
some definite and strong steps were taken by those having 
authority to take them, a waste and misapplication of money 
and effort could not fail to result. In other words, without 
association with the responsible military authorities the British 
Red Cross Society felt itself unable to carry on its functions 
under the Field Service Regulations. In view of the demands 
on the time and energies of all at the War Office at the moment 
and of the arrangement by which a representative of the Society 
was in regular attendance at the War Office, it was impracticable 
to comply with Lord Rothschild's request by appointing an 
officer of the Director-General's staff to this Standing Committee, 
but on the 3rd September, 1914, the Army Council invited Sir 
Launcelotte Gubbins, who had recently retired from the post 
of Director-General, to represent the War Office on it. 

Neither these measures nor the War Office Committee 
mentioned above were able at first to bring about full co- 
ordination of voluntary effort, or to prevent abuse of the Red 
Cross emblem. The British Red Cross Society and the Order 
of St. John continued to work independently of one another. 
On the 24th August, 1914, the Secretary-General of the Order 
of St. John, Sir Herbert Perrott, wrote to Lord Kitchener 
pointing out that endless confusion, delay, and loss of valuable 
services and of considerable financial assistance would be en- 
tailed by adherence to the regulations that offers of hospitals 
made to or by the ambulance department of the Order had 
first to be approved by the British Red Cross Society. He 
asked that the Order of St. John should be placed on the same 
footing as the Society in all matters connected with voluntary 
aid in war. 

It was thus evident that the only way in which the claims 

* Chapter V, p. 88. 



ORGANIZATION OF VOLUNTARY AID 215 

of these two influential voluntary aid organizations could be 
adjusted was by the formation of a Joint War Committee of 
representatives of both, and in order to emphasize this principle 
the Army Council sent an official notification to the British 
Red Cross Society, the St. John Ambulance Association, and 
the St. Andrew's Ambulance Association, informing them that 
they all formed part of the Red Cross organization of Great 
Britain and were recognized by the British Government as 
societies authorized to assist the medical services in time of 
war, under Article 10 of the Geneva Convention. 

Both the British Red Cross Society and the Order of 
St. John then issued circular letters to their members, that of 
the British Red Cross Society being in the following terms : 

" The British Red Cross Society, the St. John Ambulance 
Association, and the St. Andrew's Ambulance Association 
are officially notified by the War Office that they form part 
of the Red Cross organization of Great Britain, and they 
are recognized by the British Government under Article 10 
of the Geneva Convention as societies to assist the medical 
services in time of war. There has, unfortunately, been 
some friction in some parts of the country between the 
St. John Ambulance Association and the British Red Cross 
Society in its local administration. It is felt by both 
Societies that in present circumstances all these past differ- 
ences should be forgotten and laid aside, so that they should 
work in complete harmony together, and the fullest use 
be made of both organizations in the interests of the sick 
and wounded. It is desired that the County Directors and 
other officials should co-operate in every possible way to 
assist the work of both organizations equally." 

The circular memorandum of the Order of St. John was in 
similar terms, and also referred to the regrettable friction which 
existed in various parts of the country between the St. John 
Ambulance Association and the British Red Cross Society in 
local administration. 

A letter from the War Office, dated the 6th September, and 
addressed to the President of the British Red Cross Society, was 
printed with the circular saying that the Army Council was 
watching with close interest the activities of the British Red 
Cross Society, and were especially glad to learn that they were 
working in close association with other bodies recognized by 
Government as forming part of the Red Cross organization of 
Great Britain. The Council were confident that the public 
would continue to help both the British Red Cross Society and 
the St. John Ambulance Department, and in doing so would 



216 MEDICAL HISTORY OF THE WAR 

recognize also the share of the work on behalf of the sick and 
wounded which was being done by the Soldiers and Sailors Help 
Society, and the St. Andrew's Ambulance Association. 

The formation of the Joint War Committee of the British 
Red Cross Society and the Order of St. John, which became 
so well known afterwards during the war in establishing depots 
for distribution of gifts and comforts to the sick and wounded, 
and in organizing voluntary offers of ambulance cars and 
ambulance trains, followed, and came into effect on the 20th 
October, 1914, with the Hon. Arthur Stanley as chairman, and 
Sir Herbert Perrott, the Secretary-General of the Order of 
St. John, as vice-chairman. Although in a somewhat imperfect 
and modified degree, it was in practice a return to the original 
War Office conception of a Central British Red Cross Council. 

Amongst the questions which had to be decided were 
questions regarding the sale and use of the Red Cross brassard, 
the nature of the uniform to be worn by personnel of the Red 
Cross Society, the flying of the Red Cross flag over buildings, 
and the marking of private vehicles and material with the Red 
Cross. These were matters regarding which voluntary aid 
organizations and the public generally were not well informed. 

The Red Cross brassard appears to have been regarded as 
a distinctive mark of the voluntary worker at home or overseas ; 
whereas it was in reality part of the official equipment for the 
protection under the Geneva Convention of personnel of army 
medical units and establishments which might fall into the 
hands of the enemy during battle. That the personnel of 
British voluntary aid organizations would find themselves in 
that position was a remote possibility unless hostilities were 
carried on in the United Kingdom. Any other brassard than 
that stamped and delivered by competent military authority 
would, however, have no value as a protection, and might indeed 
prove harmful to the wearer.* Yet on this point the Articles 
of the Geneva Convention were either unknown, or misunder- 
stood and misinterpreted, if not actually ignored ; and many 
voluntary workers appeared in Belgium and France, as well as 

* An instance of this actually occurred. The British Red Cross Society 
had sent to Belgium a unit of 10 surgeons, 10 dressers and 20 nurses, on the 
16th August, 1914, and as they found no work to do in Brussels, two of the 
surgeons Dr. Elliott and Mr. Austin were sent by the Belgian Red Cross 
Society to the district South-east of Namur, where they found themselves in the 
midst of German troops. They were suspected of espionage, and it was some 
time before they were recognized as members of a Red Cross Society. Dr. 
Elliott stated that this was in spite of the fact that they were wearing the 
official brassard, but there is no record of an official brassard having been 
given and stamped by competent military authority in this country. 
Subsequently, when a similar party was being sent to France at the end 
of August, to open a hospital under the Director of Medical Services, official 
brassards were applied for and issued by the War Office. 



ORGANIZATION OF VOLUNTARY AID 217 

in the United Kingdom, with Red Cross brassards, for the wear- 
ing of which they had no military authority. In order to prevent 
this misuse of the Red Cross emblem, the War Office issued 
a warning to the public at the end of September, 1914, by means 
of a press communique, drawing attention to the Geneva Con- 
vention Act of 1911, under which any person acting in contra- 
vention of its provisions was guilty of an offence against the 
Act and liable to a fine of 10 and other penalties on summary 
conviction. Various complaints had been made of Red Cross 
brassards, and articles of clothing marked with a Red Cross, 
being exhibited in shop windows and ticketed for sale with such 
expressions as " very smart for present wear."* 

The only brassard which could be issued to voluntary 
organizations had to be restricted to personnel who were 
accepted for duty under military law and regulations in medical 
units of the army ; but applications at the beginning of the 
war were constantly being made for official brassards to enable 
personnel of voluntary units to proceed to France and Belgium, 
without any indication being given of the nature of the work 
they proposed carrying out or where they were going. It was 
necessary, therefore, to determine these points and ascertain 
whether such personnel could be incorporated in the medical 
establishments of the British Expeditionary Force before they 
were permitted to go overseas. An agreement had been made 
by the Chief Commissioner of the British Red Cross Society 
and the French authorities by which British Red Cross 
Society's personnel in France when assisting the French 
Army Medical Service would work under the French Military 
Command and Army Medical Service, so that it was also 
necessary to determine whether the personnel being sent to 
France were intended for assisting the French medical 
service, as under that agreement they were to be provided 
with official brassards by the French military authorities. 
The question of issue of official brassards was still further 
complicated by an application for the issue officially of 
brassards to personnel of an ambulance unit, which the British 
Red Cross Society proposed to send from England to Belgium 
to search for British sick and wounded in territory occupied 
by the enemy after the British retreat from Mons. As such 
a unit could not in any way come under the military command 
of the British Expeditionary Force, it would obviously be a 

* The attention of the War Office was drawn to this by members of 
voluntary aid detachments, county directors, chief constables, and others. 
After the appearance of the warning, the trade as a whole acted with the 
greatest desire to assist the authorities in avoiding any contravention of 
the Act. 



218 MEDICAL HISTORY OF THE WAR 

contravention of the Geneva Convention to provide its personnel 
With official brassards, and the mere fact of such brassards 
being delivered would endanger the protection which the 
Red Cross brassards were intended to give to the personnel 
of the medical units of the Army ; for the German military 
authorities would not be slow to discover any irregularity in 
their issue, and to regard such as an excuse for refusing further 
protection to army medical personnel, who might fall into 
their hands. 

The duty of the responsible military authorities was clear. 
They could not over-ride the restrictions imposed by a Con- 
vention, which Great Britain along with the other belligerents 
had ratified ; and it was impossible for them to give official 
recognition to any contravention of it which voluntary aid 
organizations might attempt. 

But the demands for official brassards by personnel, whom 
the British Red Cross Society was sending to France, became 
more and more insistent, without their being able to explain 
the nature of their duties in France, or whether they were 
going to work in French or British medical units. Arrange- 
ments were consequently made by the War Office to send the 
necessary brassards to the Director of Medical Services of the 
British Expeditionary Force. He would thus be in a position 
to issue them to those individuals who came under the control 
of the British military authorities, and the War Office would 
be spared the embarrassment of refusing brassards to personnel 
of whose ultimate sphere of activity it was ignorant. 

All these complicated questions of official brassards* were 
the main cause of the change of policy referred to in the account 
of the administration of the medical services, by which the 
responsible control of the voluntary Red Cross organizations 
in France was vested in the Director-General of the Medical 

* The issue of brassards to voluntary aid detachments had been pro- 
vided for through commands and County Territorial Force Associations 
immediately after war was declared ; with regulations as to their issue, 
record of issue, certificates of identity, numbering and stamping. It was the 
issue to irresponsible personnel that created complications. On the 17th 
October, 1914, Colonel J. Magill, the Organizing Secretary of the British Red 
Cross Society and a retired officer of the Coldstream Guards and Army 
Medical Service, was appointed by the War Office as the competent military 
authority for signing identity certificates for the members of the B.R.C.S. 
who were authorized to proceed overseas, and in March, 1915, a special 
brassard for them was issued. It was similar to the army brassard but had 
a red border, and in addition to bearing the army medical stamp, it was also 
stamped by the B.R.C.S. with the date of its issue and its number. 
Voluntary aid personnel proceeding overseas to work with the British army 
were obliged in all cases to obtain this special brassard and the identity 
certificate. Brassards issued by county directors through Territorial Force 
Associations were not recognized as brassards for voluntary personnel 
proceeding overseas. 



ORGANIZATION OF VOLUNTARY AID 219 

Services as Chief Commissioner of the Joint War Committee, 
and by which the Chief Commissioner of the British Red Cross 
Society, as an independent official, ceased to exist. 

Another question connected with voluntary aid organization 
was that of the uniform of the personnel employed by the 
British Red Cross Society. The St. John Ambulance Associa- 
tion and Brigade had already a recognized uniform, but, with 
the exception of the voluntary aid detachments, there was 
no prescribed active service uniform for other personnel of 
the British Red Cross Society. The Society consequently 
submitted details of a uniform to the War Office, but, as it 
was more or less the same as the uniform of enlisted soldiers 
and commissioned officers, it was considered that a uniform 
of that description should only be worn by personnel of 
voluntary organizations employed under the Director of 
Medical Services of the Expeditionary Force. Eventually 
the difficulties of a distinctive uniform were overcome to some 
extent by granting honorary commissions in the army to the 
Commissioners, Assistant Commissioners and others employed 
in responsible duties connected with voluntary aid organiza- 
tions. 

With regard to the use of the Red Cross emblem and flag 
on material and buildings of Red Cross organizations, the 
Geneva Convention provided for such material being regarded 
as private property. It was arranged, therefore, that the 
name of the Red Cross organization should be placed on the 
Red Cross emblem to distinguish their property from property 
belonging to the State. With regard to buildings, there was 
much popular misconception. The War Office was receiving 
numerous applications from all parts of the country, more 
especially from the eastern counties, asking for military 
authority to fly the Red Cross flag over private houses, with 
a view in many cases to secure protection against hostile 
acts on the part of the enemy. It was not understood that the 
Red Cross flag on a building indicated that the building was 
the property of the State and could, therefore, become prize 
of war in the event of its being captured. It was not, however, 
considered advisable to issue a warning to the public on this 
point, in view of the possibility of its creating alarm. But 
on the 13th August, 1914, and again on the 9th January, 1915, 
the Army Council drew the attention of military commands 
to the indiscriminate and unauthorized flying of the Red 
Cross flag over private buildings, and directed them to take 
measures to see that this practice was discontinued. The 
only buildings which were authorized to fly the flag were those 
used exclusively for the reception of sick and wounded 



220 MEDICAL HISTORY OF THE WAR 

soldiers, under the administration and control of the Army 
Medical Service. 

Although these were the principal measures adopted for 
organizing voluntary aid after war was declared, so far as the 
care and comfort of sick and wounded were concerned, it was 
difficult to discriminate between the arrangements for collecting 
and distributing gifts and comforts to hospitals under the Red 
Cross organizations and the arrangements for sending gifts 
and comforts to troops in the field. Regimental associations 
had long been in existence in connection with the army, but 
otherwise there were no voluntary organizations for adding 
to the comfort of combatant troops. Consequently on the 
outbreak of war voluntary efforts were made for this purpose 
in various directions, not only in the form of Red Cross work 
parties, but also in groups of workers who worked more or 
less intermittently, and of others who were not affiliated to 
any central organization. The latter part of 1914 and the 
early part of 1915 also saw the formation of Queen Mary's 
Needlework Guild, Queen Alexandra's Field Force Fund, the 
National Fund for Welsh troops, besides many other societies 
in various local centres. 

The object of these associations was to supply gifts in response 
to all applications which reached them personally, from officers 
and men, training camps, armies in the field, medical officers, 
matrons or nurses in military hospitals at home or overseas. 
There was no system in the mode of application or in the 
status of applicants, and although the demands were met 
as best they could by those who received them, there was 
no regular organization for dealing with the distribution 
of gifts The result was a great waste of time, labour and 
money ; unsuitable patterns of articles were produced, and 
overlapping became a very serious matter. The Army Council 
consequently felt compelled to review the whole position 
of voluntary effort and evolve a general scheme of co-ordination 
in order that the great band of voluntary workers might have 
an opportunity of developing their work on lines which would 
secure not only economy and efficiency, but the maximum 
benefit to the troops individually and collectively, whether 
at home or overseas, in the field or in hospital. It was decided, 
therefore, to form a special department of the War Office for 
co-ordinating voluntary efforts on behalf of the troops, and 
a directorate of Voluntary Organizations, with Sir Edward 
Ward as Director-General in an honorary capacity, assisted 
by Mr. Allan Hutchings, was opened at the end of September, 
1914, in offices in Scotland House, New Scotland Yard. The 
scheme prepared by Sir Edward Ward was framed on the 



ORGANIZATION OF VOLUNTARY AID 221 

basis of establishing county, city, borough, and district 
associations with local committees, under which local volun- 
tary organizations, depots, and work parties would have an 
opportunity of amalgamating as one united whole, secure 
uniformity of work, and pool resources on well-organized 
lines and with a definite programme applicable to the whole 
country. The scheme was approved by the Army Council 
and explained to the public in a circular letter to the Press 
in October, 1915. It recognized Queen Mary's Needlework 
Guild as a separate organization, by which all the work 
parties of the Guild were formed into affiliated groups under 
the Central Depot at St. James's Palace. It also recognized the 
Red Cross work parties as distinct bodies working under the 
Joint War Committee of the British Red Cross Society and 
Order of St. John, which then initiated a system of registering 
them under the Committee's head office in London. To 
prevent overlapping an understanding was arrived at in 
November, 1915, between Sir Edward Ward and Sir Arthur 
Stanley, the chairman of the Joint War Committee, by which 
the former would supply articles to military hospitals, and the 
latter to auxiliary and voluntary hospitals. This arrangement 
did not preclude the establishment of Red Cross stores in 
France and other theatres of war, for providing comforts and 
other articles to medical units in the field or on the lines 
of communication. All other workers, except those of the 
existing regimental associations, were assembled into groups 
under central offices of county, borough and district associa- 
tions. In this manner some 2,983 groups of workers, with 
approximately 400,000 workers, were attached to 267 central 
associations, and, through the Director-General of Voluntary 
Organizations, were able to supply to military hospitals several 
thousands of articles such as pyjamas, bed- jackets, bed-socks, 
and operation stockings, some six million hospital bags, 
12 million bandages and 45| million dressings of all kinds. 

The method by which the organization worked was to 
receive in the central office all requisitions from hospitals, but, 
in forwarding them to branch offices, to request the latter to 
forward the articles direct to the hospital concerned. This 
prevented local committees feeling that their contributions 
were being pooled in a large store and that they remained in 
ignorance of the final destination of their gifts. 

One of the most useful of the activities of the organization 
has already been alluded to, namely, the supply of sphagnum 
moss as a surgical dressing. At the request of the Director- 
General of the Army Medical Service in 1917, Sir Edward 
Ward's department undertook to gather, collect, treat, supply, 



222 MEDICAL HISTORY OF THE WAR 

and distribute sphagnum moss dressings to all army hospitals 
at home and overseas. In 1918, in view of the enormous 
demand for this article, a committee, known as the Sphagnum 
Moss Joint Committee, under the chairmanship of Sir John 
Duthie, and with the co-operation of Sir George Beatson, 
Chairman of the Scottish Branch of the British Red Cross 
Society, was established in Scotland as a branch of the 
Directorate of Voluntary Aid Organizations. 

In this and other directions the directorate provided a much- 
felt want in co-ordinating voluntary effort. Indeed, the chief 
lesson which the war teaches with regard to the organization 
of voluntary aid to medical services in time of war is the 
importance of peace organization in close touch with and 
co-ordinated by the military authorities. It was owing to the 
fact that this association and control existed in connection 
with voluntary aid detachments that they fell into their 
places without confusion and were invaluable from the earliest 
days ; but it was the absence of this association and control 
which caused that state of confusion and friction which was 
acknowledged to exist in other directions after war was declared. 

The subsequent development of voluntary aid on behalf 
of the sick and wounded under the Joint War Committee of 
the British Red Cross Society and Order of St. John was far 
reaching. Most valuable and highly appreciated work was 
organized by it and its commissioners in all theatres of war, 
and in the allied countries. Its activities were mainly 
directed towards the establishment of depots for distributing 
comforts and special articles of equipment to military hospitals, 
provision of recreation huts, invalid kitchens, ambulance cars, 
and motor boats, in connection with medical services generally, 
packing and forwarding of parcels to interned prisoners of 
war in enemy countries, the institution of workshops and other 
means of technical training for those interned in neutral 
countries, assistance to the victims of war amongst the civil 
populations, and helping relatives in obtaining information 
regarding the missing. All these activities were in addition to 
the work carried out in the United Kingdom in connection with 
auxiliary hospitals through the county directors of voluntary 
aid organizations, with the establishment and maintenance 
of Red Cross hospitals and officers' convalescent homes, the 
organization of war libraries, and the after-care of disabled 
soldiers. These and other details of the immense extent 
of its work will be found in the report of the Joint War 
Committee, and in the history of the medical services of the 
various expeditionary forces. 



CHAPTER XII 

DEMOBILIZATION. 

E medical services had several important functions to 
JL perform in connection with demobilization. Measures 
had to be taken for the disinfection and disinfestation of men 
and their clothing before transfer to the United Kingdom; 
for medical examination of men claiming compensation in 
consequence of disability ; for "the disposal of the hospital 
populations overseas and in the United Kingdom ; for the 
disposal of medical and surgical stores ; and for the demobi- 
lization of medical units and medical personnel. 

The measures of disinfection and delousing of healthy men 
were conducted in theatres of war before embarkation for the 
United Kingdom, but it was anticipated that large numbers 
would disembark in British ports in a verminous condition, 
especially from more distant theatres of war and at the com- 
mencement of demobilization. Special arrangements for their 
disinfection were consequently to be made at the ports of dis- 
embarkation by the military authorities of the commands 
concerned. Details of the general measures for delousing are 
described in the volumes on the Hygiene of the War. 
Generally they followed the quarantine methods employed by 
the Japanese for the troops returning from Manchuria on the 
termination of the Russo-Japanese War.* 

On arrival in the United Kingdom drafts for demobilization 
were sent to dispersal stations, specially organized for demobi- 
lization purposes in each command, but before leaving their 
units each officer and man had to be examined medically to 
ensure that he was fit to travel and free from infection, and in 
order to have his medical category reviewed and revised where 
necessary. Each officer and man had to declare on a certificate 
form that he did or did not claim compensation for disability. 
If he did, the medical officer of the unit had to examine him 
with reference to his claim and complete the form of statement 
of disability in order to assist the Ministry of Pensions in 
subsequently adjusting the amount of compensation. 

With regard to the dispersal of the hospital population, the 
policy adopted was to demobilize all sick and wounded who had 

* See Report No. 36 of " Medical and Sanitary Reports of the Russo- 
Japanese War," published for H.M. Stationery Office, p. 463, et seq. 

223 



224 

been more than 28 days in hospital and to return to their units 
those who were fit for duty within 28 days. Everyone so 
demobilized had to appear before a medical board, when his 
disability was fully recorded in medical board proceedings, which 
for the hospital population took the place of the statement 
of disability of officers and men who were demobilized from 
their units. For this purpose certain large hospitals in each 
command, usually the principal central hospitals, were selected 
as dispersal hospitals, and a medical board consisting of an 
equal number of medical officers appointed by the War Office 
and Ministry of Pensions was allotted to each. The main 
duty of these boards was to determine the necessity or other- 
wise for further indoor 9r outdoor treatment, which might be 
provided by the Ministry of Pensions ; to recommend for the 
discharge, under existing procedures of invaliding, of officers 
and men who were permanently unfit for further service ; 
and to assess disability pensions either finally or temporarily. 
In the event of disagreement amongst the members of the 
board, cases were to be referred to a standing appeal board 
and the patients retained in hospital pending its decision. 

At first there were some fifty dispersal hospitals, and it was 
intended that patients should be transferred to the dispersal 
hospital nearest their homes. The number was gradually 
reduced as the numbers of sick and wounded for disposal 
diminished. The constitution of the dispersal medical boards 
was also altered, at first to two officers R.A.M.C. and one 
representative of the Ministry of Pensions, and afterwards to 
three officers R.A.M.. and no representative of the Ministry 
of Pensions. 

The procedure for concentrating the hospital population in 
dispersal hospitals was to evacuate to the United Kingdom 
all sick and wounded from overseas, whenever shipping was 
available, provided they were in need of at least 14 days' 
hospital treatment from the date of embarkation ; and to 
transfer from affiliated to central hospitals or appropriate 
special hospitals the patients in the United Kingdom who 
were likely to require more than 28 days' treatment. Sick and 
wounded, thus concentrated, were discharged from the service, 
if permanently unfit, by the standing invaliding medical 
boards of the hospital, others were transferred as accommo- 
dation became available to the dispersal hospitals, with 
the exception of those requiring transfer to special hospitals 
or patients of the Dominion or American forces, who were 
transferred to their own hospitals. 

By these means the auxiliary and affiliated hospitals were 
gradually closed and subsequently, too, those central hospitals 



DEMOBILIZATION 225 

which were not required as dispersal hospitals.* Special 
hospitals, which were required for prolonged treatment of 
disabled men, were eventually taken over by the Ministry of 
Pensions, but for a considerable time after peace with the 
Central European Powers was signed they remained under the 
charge of the Army Medical Service. 

The sick and wounded in convalescent hospitals were disposed 
of in the same manner as the patients in the affiliated hospitals. 
Officers and men in command depots were disposed of through 
the militaiy dispersal stations unless requiring hospital treat- 
ment, when they were transferred to central hospitals. In this 
way the convalescent hospitals and command depots gradually 
closed. 

With regard to the disposal of medical stores, boards took stock 
in the first instance of all stores in possession of medical units, 
conditioned them and classified them into serviceable, repairable 
and unserviceable. Serviceable stock was retained for issue 
as required ; repairable was packed and sent to base depots 
of medical stores in the United Kingdom ; the unserviceable 
stores were handed over to the Salvage Department. 

The base depots had to be very largely expanded for the 
reception of these stores. They were divided into 14 sections 
comprising different classes of stores, such as medicines, 
vaccines and sera, tablets, surgical dressings, rubber and 
waterproof goods, surgical appliances and spectacles, surgical 
instruments, operation room furniture, field equipments, X-ray 
apparatus and appliances, dental apparatus and appliances, 
chemical and bacteriological apparatus, packing cases and 
bottles, stationery and ordnance stores. 

Medical units not required for the post bellum army were 
demobilized by reduction to a cadre establishment until their 
medical and ordnance stores and equipment had been disposed 
of, the surplus personnel being posted either as reinforcements 
to units which were being retained, or sent to the dispersal 
stations in the United Kingdom for demobilization in accord- 
ance with the general instructions. 

The demobilization of medical officers was carried out under 
special instructions and presented many difficulties. In con- 
sidering the steps taken to bring about their demobilization 
the policy of the War Office was largely dictated by the civilian 
bodies which had been set up during the war with a view to 
providing civilian medical men for service with the army, and 
also by the fact that although the great majority of officers 
were liable to be retained compulsorily until the statutory 

* The rate of demobilization of hospital accommodation is shown in the 
chart of hospital beds in Chapter V. 

(1735) Q 



226 MEDICAL HISTORY OF THE WAR 

date for the end of the war, in actual practice public opinion 
after the declaration of the Armistice demanded prior con- 
sideration for the needs of the civilian population and even for 
the claims of individual medical officers. 

Hospital populations, however, did not diminish pari passu 
with the demobilization of the rest of the army, and the garrisons 
which remained in occupied enemy countries consisted largely 
of small bodies of troops scattered throughout wide tracts 
of country, thus requiring a very much larger proportion of 
medical officers for field duties, sanitation, and other medical 
requirements, than had been the case when the troops were 
more or less concentrated as armies in the field. 

Some time prior to the declaration of the Armistice it was 
realized that special machinery would be required for the 
demobilization of the officers of the Royal Army Medical Corps 
and that the general machinery of demobilization, although 
suitable in the case of other ranks of the Corps, would not 
be applicable to them. There were, broadly speaking, three 
methods, any one or any combination of which might be 
adopted in deciding upon a scheme of demobilization of 
medical officers : 

(1) To release the greatest possible number in the shortest 

time, by ordering the demobilization of every 
medical officer immediately his services were no 
longer essential for local requirements. 

(2) To release officers from each command or expeditionary 

force according to length of service, age, and urgent 
family affairs. 

(3) To release only those officers whose demobilization 

was urgently required on account of the needs of 
the civil population in the localities in which they 
had practised before joining the Royal Army 
Medical Corps. 

It was believed that the essential factor for rapid demobiliza- 
tion would be to retain as far as possible officers who could 
not be spared without being relieved by others, and to release 
immediately those who could be spared, thus avoiding the 
necessity for constant movement of officers and handing over 
of duties. If a policy of this kind were acted on it was obvious 
that the greatest possible number in any given period would 
be released by the first method and the next greatest number 
by the second method, as offering a wider selection of eligible 
individuals than the third method. 

Unfortunately, at the time of the Armistice the civil population, 
which had been seriously depleted of medical men, was menaced 
by the danger of an epidemic of influenza making the immediate 



DEMOBILIZATION 227 

return of a large body of medical men to civil life a matter 
of the greatest urgency. It was therefore decided that the 
Medical Department of the Ministry of National Service and 
through them the Central and Local Medical War Committees, 
which had been mainly instrumental in supplying medical 
men for service in the army, should reverse their functions and 
provide for the restoration of medical men from the army 
to civil life. 

The War Office and the Ministry of National Service in 
considering the best method of demobilization came to the 
conclusion that the first method would be unsatisfactory, 
both from the point of view of the individual officer and of 
the civil community, but, while the War Office favoured the 
second method as releasing the greatest number of officers 
consistent with the principle of demobilizing first those 
with the greatest claim to consideration, the Ministry of 
National Service favoured the third method as a means of 
returning most rapidly to civil life those medical men who had 
large panel practices. 

Consequently, in view of the serious epidemic of influenza, 
the third method was adopted and the following machinery 
set in motion. The Local Medical War Committees forwarded 
to the Central Medical War Committee the names of those 
practitioners who were most urgently required in their own 
localities. The Central Medical War Committee considered 
these lists and made recommendations to the Ministry of 
National Service, who forwarded the names to the War "Office 
in the order in which release was desired. The War Office 
then forwarded the names to the commands in which the officers 
were serving, and they were then released as early as possible 
in the order in which their names were received. Foreseeing 
that there would be considerable delay in releasing large 
numbers if this system were adopted in its entirety, the 
\Var Office advocated a compromise between the second and 
third methods of release, 50 per cent, of those released to be 
from names submitted by the Ministry of National Service, 
and 50 per cent, from amongst officers selected by the commands 
concerned with a view to demobilizing as early as possible 
officers who claimed priority of release on account of length 
of service and other personal considerations. The Ministry 
of National Service could not, however, agree to this on the 
grounds that the release of those officers whom they had 
demanded by name would be delayed by the demobilization 
of any others. Consequently, demobilization was confined to 
those whose release had been demanded by that Ministry. 

As had been foreseen by the War Office authorities, this 

(1735) Q 2 



228 MEDICAL HISTORY OF THE WAR 

system of demobilizing medical officers was unworkable and 
involved constant movement and replacement of officers and 
the consequent handing over of duties. In many cases, no 
sooner had an officer taken over the duties of one whose release 
had been requested than he himself was demanded, and it 
became necessary again to hand over the duties. Further, 
many of those whose release was asked for were servirig in 
distant theatres of war and either could not be spared without 
a relief, or could not be sent home on account of lack of shipping, 
or were specialists who could not be spared. Moreover, the 
demands for the release of officers were frequently based on 
the fact that they held special qualifications. For example, 
mental specialists were required for the Board of Control, 
venereal experts for the Ministry of Health, and orthopaedic 
surgeons for the Ministry of Pensions, whereas the number of 
cases which these officers were required to treat in the army 
showed very slight decrease or even in some cases an increase 
for a long time after the Armistice. 

It was during this phase of demobilization that the card 
index, which had been so laboriously completed during hos- 
tilities, proved of the utmost service. Not only had complete 
details of every officer and where he was serving been entered 
on his card, but there was also a record of his special quali- 
fications and any special duties he had been or was actually 
performing at the time. With the information available from 
the cards it was possible, therefore, to find substitutes for 
many " of the officers employed on special duties, although 
these substitutes were not at the time employed as specialists. 

Representatives of the Director-General of the Army Medical 
Service attended many conferences at which representatives 
of all the different civilian bodies were present, and frequently 
pointed out that the only way to return medical officers to their 
civil duties with any degree of rapidity was by allowing the 
War Office to nominate those who could best be spared. In 
fact, a definite promise was given that, if the Ministry of 
National Service would agree to this, 2,000 medical officers 
would be returned within a very short time. This, however, 
was not agreed to, and, as a result, only 2,531 medical officers 
had been demobilized by the llth March, 1919. The situation 
in civil life had then become so serious that the Secretary of 
State for War, in consultation with the Minister of National 
Service, handed over the whole system of demobilization of 
medical officers to the Director-General of the Army Medical 
Service. 

It was then estimated that, with a free hand, 2,000 could be 
released, and in fact between the llth March, 1919, and the 



DEMOBILIZATION 229 

8th April, 1919, the number demobilized rose to 5,463, a total 
of 2,932 having been released in four weeks. The situation 
in civil life was eased by this large influx of doctors, and 
demobilization was subsequently carried out by a combination 
of the second and third methods, the arrears of those who had 
been demanded and whose release was still outstanding being 
cleared off concurrently with the release of those who had 
been selected by the General Officers Commanding in Chief 
of the various forces on account of length of service, age, and 
family requirements. A great many officers who had served 
since the first year of the war were, for one reason or another, 
not demanded by the Ministry of National Service, and it 
had been hoped that as soon as the Ministry's demands had 
been cleared, it would have been possible to release them. 

By the time 9,070 had been released, the number of medical 
officers employed had been reduced to a minimum, and the 
demobilization of other arms had become very much slower. 
Consequently it was found that medical officers then could only 
be released very slowly and at such times as reductions were 
made in the army generally. In order to hasten their release, 
however, new contracts for shorter periods were offered to 
civilian doctors who had just qualified or who, after their 
return to civil life, were anxious to rejoin the Royal Army 
Medical Corps, those who responded being posted to the 
various forces in relief of others who were anxious to return 
to civil life. 

Had this system of release, which had been advocated 
throughout by the War Office, been adopted from the outset 
of demobilization it is probable that not only would a great 
deal of dissatisfaction have been avoided among medical 
officers with long service who saw comparatively young men 
with sometimes only a few months' service released on demand 
by the Ministry of National Service, but the civil situation 
would probably have been relieved much more rapidly, as was 
proved to be the case when the system of demanding by 
name was discontinued. In isolated and very exceptional 
cases it would have been necessary, whatever system had 
been in force, to demand certain individuals by name, but the 
number so demanded would have been limited and would 
have been the subject of close investigation by the Ministry of 
National Service. 

In offering new terms of temporary commissions in order 
to replace released officers it was realized that after five years 
of war most medical men were anxious to return to civil life 
and that young men who were qualifying would be more 
anxious to prepare themselves as rapidly as possible for their 



230 MEDICAL HISTORY OF THE WAR 

future occupation by accepting appointments in civil hospitals 
than by serving for an uncertain period as officers of the Royal 
Army Medical Corps. Consequently increased emoluments in 
the form of a contract providing for pay at the rate of 500 
per annum for those joining for the first time and 550 for those 
who had served previously for a period of not less than one 
year were offered and employment for one year was guaranteed. 
This contract came into force on the 1st August, 1919, but so 
small was the response that it immediately became necessary 
to offer further increases and in September the terms were raised 
to 600 and 650 per annum. 

When this contract was proposed it was strongly urged by 
the Director-General that it should, like the previous one, 
provide for employment for a period of not less than one year, 
but after considerable discussion this was overruled and the 
period of employment was fixed at six months. This shorter 
period added greatly to the difficulties of the medical depart- 
ment at the War Office in connection with the provision of 
personnel for the medical requirements of forces occupying 
distant theatres of war. It was impossible to send officers 
on so short a term to the Far East, and reliefs for those in 
Mesopotamia, who though in every way deserving of con- 
sideration in respect of early demobilization could not be 
spared without relief, were not possible. Every effort was 
made to release them but, although every regular officer who 
could be spared was sent to Mesopotamia, the numbers 
available fell far short of those required. The compulsory 
retention of Special Reserve, Territorial Force and temporary 
officers in that country consequently gave rise to much 
dissatisfaction, an endless amount of correspondence and 
numerous questions in Parliament. 

Moreover, delays in shipping were serious and it was fre- 
quently the case that an officer, who had joined for six months 
and for whom a passage had been asked immediately on joining, 
had not embarked until half the period of his contract had 
expired, and it was, therefore, necessary to cancel his orders 
and to continue to employ him on home service until such 
time as his contract expired. In these circumstances it was 
only by reducing the number of medical officers in garrisons 
and expeditionary forces to a dangerous point that a certain 
turnover could be maintained and demobilization proceeded 
with. 

For a considerable time after the Armistice the work in the 
home hospitals diminished only very slightly. Large numbers 
of sick were being evacuated from the various expeditionary 
forces, and the Ministry of Pensions had not yet taken over 



DEMOBILIZATION 231 

pensioner cases. In order to maintain a proportionate rate 
of demobilization at home, it was necessary, therefore, to post 
junior officers, who were discharged to duty from hospital 
or had returned from overseas, to the Home Commands in 
relief of others whose release had been demanded by the 
Ministry of National Service. The services of part-time civil 
medical practitioners were also utilized to the greatest possible 
extent and not only brought about the release of a greater 
number of officers than would otherwise have been possible, 
but also gave some financial assistance to those who had 
recently been demobilized and who were picking up the threads 
of their practices. They were given preferential treatment 
in selecting civil practitioners for part-time work with the 
army. 

The work of demobilizing several thousand medical officers 
involved endless correspondence, personal interviews and many 
other matters connected with their return to civil life. The 
number of questions and enquiries reaching the medical 
department of the War Office regarding the release of officers, 
both from private correspondence and from public bodies, 
ran into many hundreds daily, and in order to keep an accurate 
and accessible record of each officer's situation as regards 
release, it was necessary to start a demobilization card index. 
A card was made out for each officer whose name was sub- 
mitted for release. The cards were then sent to the main 
index and divided into batches according to the theatres of 
war in which the officers were serving and these batches of 
cards were used as nominal rolls in typing telegrams for 
ordering release and in notifying the Ministry of National 
Service of the action taken. The fact that this had been done 
was then entered on the cards. On completion of the pre- 
liminary action the cards were incorporated in the demobiliza- 
tion index in alphabetical order for any further entry, such as 
" embarked for United Kingdom," which would be recorded 
in due course and available in replying to further enquiries 
regarding the officer's progress towards release. On 
demobilization being completed the card was withdrawn to 
an index of demobilized officers. The remaining cards, 
which would consequently be those of outstanding cases, 
were reviewed monthly and reminders were sent to the com- 
mands concerned. This system not only reduced by half the 
clerical labour but also enabled the enormous number of 
enquiries to be answered promptly. The superiority of the 
card index system in dealing with large numbers of individuals 
and masses of correspondence was thus amply demonstrated. 
Without its adoption, not only would demobilization of medica 



232 MEDICAL HISTORY OF THE WAR 

officers have been very seriously delayed, but it would have 
been impossible to answer the innumerable enquiries or to 
produce evidence in justification of the policy adopted by the 
medical department of the War Office, which at that time 
became the object of frequent and bitter attacks both in the 
Press and by public bodies. 

Up to the 1st of June, 1920, the total number of medical 
officers who were released from service with the Royal Army 
Medical Corps, including those of the United States of America 
and Dominion Medical Services, was 11,627. 

The demobilization of other ranks of the Royal Army 
Medical Corps was carried out as already stated on the lines 
laid down for the rest of the army, and, as all instructions 
were issued by the Mobilization Directorate, no special 
machinery was necessary in the medical department of the 
War Office. Nevertheless it was of the greatest importance 
that an accurate check should be kept on the total numbers 
released and that it should be possible to follow the progress 
of demobilization in relation to the reduction of hospital beds. 

Shortly after the Armistice it was necessary to effect the 
release of the largest possible number of the other ranks of the 
Royal Army Medical Corps, eligible for demobilization^ with 
the least possible delay. The main causes which retarded 
demobilization were the delay in the surrender of hospital 
beds, when viewed in conjunction with the decline in hospital 
population, and the small number of units closed down since the 
date of the armistice. These points were brought to the notice 
of the deputy directors of medical services in the home 
commands in a circular letter issued by the Director-General 
on the 3rd of May, 1919. It was pointed out that Royal Army 
Medical Corps personnel should be available for demobilization 
by a redistribution of personnel not eligible for demobilization, 
and that men of the R.A.M.C. should be demobilized in priority 
to voluntary aid detachment general service women, as the 
slow release of the men was causing grave concern at the time. 
Further, at the time the letter was written, 11,000 of the 
R.A.M.C. were beftig retained for the military machinery of 
demobilization, a state of affairs which it was impossible 
to justify. 

A few weeks later a further letter was sent to General 
Officers Commanding all commands at home stating that it 
had been decided to base establishments on the number of 
equipped beds only in special hospitals and in those selected 
for the reception of convoys, and in all others on the number 
of occupied beds. In estimating requirements the proportion 
of personnel to be retained was not to exceed one officer to 



DEMOBILIZATION 233 

75 beds, 20 other ranks to 100 beds, and, where voluntary aid 
detachment general service women were also employed, a com- 
bined total of subordinate personnel of 25 to 100 beds. 

As a result of these instructions and of the careful system 
of checking establishments, not only of commands as a whole 
but of individual units, large reductions took place, and from 
then onwards the number of demobilizable men previously 
retained as necessary for the machinery of demobilization 
showed a steady decrease. This was aided by the rapid 
decreases which were now taking place in the hospital popu- 
lation, by the employment to the greatest possible extent of 
voluntary aid detachment general service and labour women, 
and later, as demobilization progressed and recruiting for the 
R.A.M.C. fell far short of the numbers required, by the general 
employment of civilian hospital orderlies. 

The system of checking establishments employed was made 
as automatic as possible and charts were compiled from 
weekly returns showing the numbers of officers, other ranks 
and women continuing to be employed and the number 
required for the medical care of sick and wounded, medical 
charge of troops and miscellaneous duties. This could other- 
wise have been done only by the examination of masses of 
returns. 

As a result of this system it was found that any waste of 
personnel in commands immediately came to notice, but it 
was only by continuous telegrams, letters and instructions to 
commands that staffs were maintained at the minimum con- 
sistent with efficiency. 

One of the greatest difficulties encountered was the disposal 
of ordnance and medical stores after a unit had been closed 
for the treatment of patients. The long delays which occurred 
meant the continued occupation of costly premises and the 
employment of a nucleus staff, including usually a senior officer 
who was responsible for the stores, sometimes for many months. 
On any future occasion it should be possible, by a closer liaison 
between the various departments to secure the rapid closure 
of all units and consequent early release of staff and buildings. 

Graphic charts were maintained in the Director-General's 
office showing the demobilization of subordinate ranks 
of the Royal Army Medical Corps, of voluntary aid de- 
tachment general service women, and of Royal Army Medical 
Corps officers and civil medical practitioners. Originally 
it was the practice to rely upon the receipt of a demobi- 
lization form as notification of an officer's release, but the 
delay in the receipt of this form was so great that it was 
found impossible to keep the progress of demobilization both 



234 MEDICAL HISTORY OF THE WAR 

of individuals and of Royal Army Medical Corps officers as 
a whole up to date. Commands were therefore instructed to 
telegraph to the medical department at the War Office the 
name and date on which each medical officer ceased to perform 
military duties and records were compiled from these telegrams 
and later confirmed on receipt of the army form. This 
served a double purpose. It not only showed the decrease in 
medical officers in each command day by day, but it helped 
to distribute to commands those medical officers who were 
returning from expeditionary forces but whose turn for 
demobilization had not yet arrived. 

Members of the nursing services, of voluntary aid detach- 
ments and general service voluntary aid detachments were 
also demobilized under special instructions. Generally the 
procedure was the same as for officers and other ranks. 
Dispersal hostels were opened at Folkestone* for those from 
France and Italy, and at Brockenhurst for those from other 
theatres of war. The matron in charge of a hostel then carried 
out the duties of dispersal on the same lines as those laid 
down for an officer in charge of a dispersal station. 



* Transferred in October, 1919, to the Connaught Club, London. 



CHAPTER XIII 

THE MEDICAL SERVICES IN THE MEDITERRANEAN GARRISONS 

THE Mediterranean garrisons, Malta and Gibraltar, formed 
medical bases to which sick and wounded from Mediter- 
ranean theatres of war were evacuated. 

MALTA. 

The medical work in Malta during the early months of the 
war consisted of the ordinary routine work of a peace garrison. 
Malta fever, which in the past had thrown a considerable 
amount of strain on the medical services, had been eliminated 
for some years before the war, and the garrison was a healthy 
garrison, so that the medical work during these early months 
was easy. At the time war was declared there was no indi- 
cation that active operati ons would take place in any theatre 
of war on the Mediterranean littoral, at any rate so far as 
Great Britain was concerned, and officers and men of the 
regular R.A.M.C. were withdrawn for active service elsewhere. 
The peace medical establishment was 23 officers including two 
quartermasters, 150 other ranks R.A.M.C., and 12 members 
of the Q.A.I.M.N.S. 

As the British infantry battalions were withdrawn their 
place was taken by the two battalions of Malta Militia, and 
by battalions of the Territorial Force from England. The 
latter were accompanied by four R.A.M.C. (T.F.) officers, and 
four officers and 193 other ranks of the 1st City of London 
Field Ambulance (T.F.). Consequently before there was 
active need of hospital expansion these formed the bulk of 
the military medical personnel on the island. 

Colonel M. W. Russell, the D.D.M.S., as noted already, 
returned to England in September, 1914, and was not replaced 
at the time. The duties of D.D.M.S. were carried out by 
Lieut.-Colonel Sleman, R.A.M.C. (T.F.), who came to Malta 
in command of the 1st City of London Field Ambulance. 
Lieut.-Colonel C. C. Gumming, R.A.M.C., acted as his 
D.A.D.M.S. 

The military hospitals in Malta before the war period were 
four in number. The main hospital and headquarters of the 
R.A.M.C. was the military hospital at Cottonera, with 278 beds, 
and there was a comparatively modern hospital in the centre 
of the island at Imtarfa with 55 beds. At Forrest there was 

235 



236 MEDICAL HISTORY OF THE WAR 

a small hospital of 20 beds, chiefly for venereal diseases, in an 
old monastery surrounded by high walls enclosing an old time 
garden. In Valetta itself, what had been in days gone by the 
largest and oldest military hospital in the island with its famous 
ward 505 feet in length, once the principal hospital of the 
Knights of Malta, and capable of accommodating some 300 beds, 
had been reduced to a hospital of 36 beds, of which all but 
ten formed a hospital for Maltese troops, known as the Royal 
Malta Artillery Hospital. There was also a small military 
hospital at Fort Chambray in the outlying island of Gozo, 
and a large naval hospital at Bighi near the Cottonera 
military hospital. 

The first indication of the probable use of Malta as a hospital 
base in the Mediterranean came on the 24th February, 1915, 
when a telegram was received from Egypt enquiring to what 
extent Malta could provide hospital accommodation. Five 
hundred beds were immediately offered, but a few days later, 
on the 3rd March, information was received from Egypt that 
the accommodation would not be required. 

The imminence, however, of operations taking place in the 
Dardanelles induced Lord Methuen, the Governor and 
Commander-in-Chief in Malta, to initiate the preparation of 
a scheme locally for expanding its hospital accommodation 
to 3,000 beds and for forming a convalescent depot for 
500 in Gozo. The scheme was forwarded to the War Office 
for sanction on the 14th March, 1915, as well as to the 
General Officer Commanding in Egypt, and preliminary 
measures were taken to give effect to it. On the 19th March, 
1915, the Commander-in-Chief was asked if Malta could 
receive 500 venereal patients from Egypt. Arrangements 
were made at once and the men arrived within a fortnight. 

There was not, however, at this time any indication from 
Egypt of the need of any great expansion of hospital accommo- 
dation in Malta, but this did not prevent the military authorities 
from carrying out the preliminary arrangement for providing 
3,000 beds, the provision for 1,200 of which was sanctioned 
by the War Office on the 12th April, 1915. 

When the expeditionary force landed in Gallipoli on the 
25th April, 1915, it was evident that the scheme would have 
to be put into operation immediately and to its fullest extent. 
The first convoy of wounded, numbering some 600, arrived 
on the 4th May, 1915, and convoys continued to arrive during 
the month, so that by the end of May the number of sick and 
wounded in the island exceeded 4,000. 

Local arrangements were then 'commenced to increase the 
hospital accommodation to 7,000 beds. Sir Frederick Treves 



OF HOSPITALS AND 
CAMPS IN MALTA. 



EH Hospitals. 
Convalescent Camps. 
j-f- Small Hospitals in Private Buildings. 
\f* = * Roads. 
**" Railways 



'A o. 



Scale of English miles. 




MEDITERRANEAN GARRISONS 237 

visited Malta at this time and recommended the formation 
of a hutted hospital for 2,000 beds on the Marsa. This was 
a low-lying site at the head of the Grand Harbour, liable to 
flooding by rain. This site was strongly objected to by the 
local authorities.* Consequently when, in accordance with 
the recommendation, 34 huts were sent out from England, 
a site was selected for them on higher ground near St. 
Andrew's barracks, overlooking the rifle ranges at Pembroke, 
where they were eventually erected by the end of October, 
1915, and designated the St. Paul's Camp Hospital. 

By the end of June, 1915, 2,000 more sick and wounded 
arrived in Malta, but, notwithstanding this, the numbers 
in hospital did not exceed 4,000, as about 1,000 had been evacu- 
ated to England and about the same number had been returned 
to Egypt. The numbers, however, steadily increased during 
the next three months, and by the end of September had 
reached 10,517. During the previous three months over 
22,000 sick and wounded had arrived in Malta, 13,000 had 
been transferred to England, and 3,500 sent back to Egypt 
as fit for service. Work in the hospitals was very heavy during 
this period, for in addition to battle casualties many of the 
men were suffering from dysentery and fevers of the enteric 
group. During October, November and December, 1915, sick 
and wounded continued to arrive from Gallipoli at the rate of 
about 2,000 weekly, and in one week in December as many as 
6,341 were landed in Malta. 

At the end of 1915 owing to the evacuation of Gallipoli the 
medical situation in Malta was completely altered for a time. 
Although sick and wounded began to arrive from Salonika 
the number was not then great and the importance of Malta 
as a hospital base diminished. In February, 1916, only 600 
sick and wounded were received, and in March 1,500. By 
the end of the month there were only 4,000 in the Malta 
hospitals, although the accommodation at that time amounted 
to 20,000 beds. It was consequently decided to reduce the 
hospital accommodation to 12,000 beds at the end of March, 
and for the next three months the medical services in Malta 
passed through a period of comparative inactivity ; the 
numbers in hospitals and convalescent depots fluctuating 
between 3,000 and 5,000. 

* Heavy rains in November completely flooded the Marsa in four hours 
during the night. The local military and medical authorities were not only 
justified in their opposition to the site, but they also opposed the use of. huts, 
as being unsuitable for occupation during the hot weather in Malta. ' They 
were in favour of temporary stone buildings, which they considered could 
have been constructed more quickly. 



238 MEDICAL HISTORY OF THE WAR 

In July, 1916, the outbreak of malaria amongst the troops 
in Macedonia made it necessary not only to restore the hospital 
accommodation which had been provided for sick and wounded 
from the Dardanelles, but to increase it still further. Convoys 
arriving in July, 1916, numbered 718, 1,982, 2,605 and 2,587 
in successive weeks. During that month the hospital and 
convalescent depot accommodation was raised to 15,486 
beds, and eventually to 25,570, with a scheme for further 
expansion to 27,000. This expansion was effected by adding 
beds, chiefly by means of tentage, to the hospitals formed in 
1915, instead of by the formation of new hospitals. 

In 1917 a new situation was created. Submarine attacks 
on hospital ships in the Mediterranean made it unsafe to 
continue evacuation from Salonika to the same extent as 
previously. The policy was then adopted of retaining sick 
and wounded in Salonika, and increasing the hospital accommo- 
dation there. Five general hospitals consequently were ordered 
to mobilize in Malta for service in Salonika.* They left during 
May, 1917, and the accommodation in Malta was reduced to 
12,932 beds. The effect of the new policy on Malta was soon 
felt, for in May, 1917, only 603 sick and wounded arrived 
as compared with 2,543 during the previous month. In June 
only 37 arrived, in July 842, and in August 401. At the 
beginning of May, 1917, 14,537 sick and wounded were in the 
Malta hospitals and at the end of August only 5,465. 

The importance of Malta as a hospital base was thus per- 
manently diminished, but it had fulfilled its purpose well 
during the two phases of maximum activity ; namely, during 
the Dardanelles operations in 1915, and during the period of 
malarial prevalence in Macedonia in 1916. In 1915, 2,550 
officers and 55,400 other ranks were received from the 
Gallipoli expeditionary force, the maximum number in hospital 
on any one day being 16,004. From Salonika 2,600 officers, 
including members of the nursing services, and 64,500 other 
ranks were landed up to August, 1917, the majority arriving 
during the summer and autumn of 1916. 

From September, 1917, to October, 1918, the hospital and 
convalescent depot accommodation was gradually reduced 
from 12,932 to 7,734 beds. The epidemic of influenza in 1918 
caused a slight increase to 9,218 beds in November, but after- 
wards a rapid reduction was made by evacuation of sick and 
wounded to England, so that by February, 1919, only 476, 
equipped hospital beds remained in the island. 

* These hospitals became the 61st, 62nd, 63rd, 64th, and 65th General 
Hospitals with 1,040 beds each, completely equipped and staffed from 
Malta. 



MEDITERRANEAN GARRISONS 239 

A feature of historical interest in connection with Malta 
as a great hospital base during the war is the fact that the 
hospitals and convalescent depots were not provided by the 
mobilization of general or stationary hospital units from 
the United Kingdom, but were entirely of local constitution, 
personnel and equipment being sent from England as required. 
The policy was thus in a sense local and did not necessi- 
tate much reference to the War Office authorities or other 
commands. 

Individual hospitals were classified in four groups, namely 
those expanded from existing hospitals, hospitals opened in 
vacated barracks, hospitals in civil buildings, and hospitals 
formed in camps. 

The first group consisted of the Gottonera, Forrest, Valetta, 
and Imtarfa hospitals. 

The expansion of the Cottonera hospital was effected by 
conversion of the verandahs and R.A.M.C. barracks into 
wards, the beds being increased in this way from 167 to 432. 
A further expansion to 802 beds was made in October, 1916, 
by tentage. This hospital remained throughout as the prin- 
cipal hospital for surgical cases. 

The Forrest hospital was retained in its original role as 
a hospital for contagious diseases, and was expanded from 
30 to 186 beds, mainly by tentage. 

The Valetta hospital was expanded by re-opening and re- 
fitting the large disused wards, and, at its maximum expansion, 
provided 524 beds. It was used generally as a hospital for 
medical cases. 

The Imtarfa hospital adjoined the Imtarfa barracks and 
became merged in the hospital opened in the latter. It was on 
the healthiest site in the island on the high ground in the centre 
of Malta. A large new military hospital was in process of 
construction there to replace the hospital at Cottonera, but 
it was not sufficiently advanced to be used during the war. 

The second group of hospitals was in the infantry barracks 
at Imtarfa, St. George's, St. Andrew's, and Floriana, in 
artillery barracks at Tigne and Ricasoli, and in old buildings or 
huts in Baviere and Fort Manoel. 

At Imtarfa 300 beds were equipped in the barracks at the 
beginning of April, 1915, specially for the venereal patients 
sent from Egypt. Subsequently more barrack rooms were 
equipped, until in October, 1916, a maximum hospital accommo- 
dation of 1,853 beds had been reached. This number of beds 
was maintained till August, 1917, when there was a slight 
reduction. The hospital was finally closed in February, 1919. 
It was used mainly as a hospital for dysentery and other infectious 



240 MEDICAL HISTORY OF THE WAR 

diseases. The number of cases of the enteric group which 
arrived from Gallipoli and Salonika was comparatively small , 
and dysentery cases occupied most of the beds. 

In St. George's barracks a non-dieted hospital, with barrack 
room equipment, was opened for slightly wounded in May, 

1915. It became a fully equipped dieted hospital by Septem- 
ber, when the number of beds was increased from 840 to 1 ,000. 
A further expansion was made chiefly by tentage in July, 1916, 
reaching a maximum of 1,412 beds in September of that year. 
This hospital was closed at the end of October, 1917. 

St. Andrew's barracks were handed over to the Royal Army 
Medical Corps on the 6th May, 1915, and opened as a hospital 
three days later. By the 12th May 845 beds had been 
equipped and 300 patients admitted. By the end of the month 
1,172 beds were ready. Further expansion up to 1,258 beds 
was made by adding tentage, and maintained until March, 

1916. The accommodation was then reduced to 1,070 beds, 
but again expanded by tentage in July and August, 1916, 
to 1,782 beds. This number was maintained till August, 

1917. when gradual reduction commenced and the hospital 
was closed on the 21st January, 1919. Like the Imtarfa 
hospital, it was used chiefly as a hospital for dysentery after 
September, 1915. 

The hospital in the Floriana barracks, just outside Valetta, 
was opened in June, 1915, with 600 beds and increased to 
700 in November. It was closed in April, 1916, but re-opened 
with 704 beds in September of that year. In December, 1916, 
the accommodation was increased to 1,304 beds by erecting 
hospital marquees on the parade ground. The hospital was 
finally closed on the 30th April, 1917. The majority of the 
cases treated in it were cases of severe wounds requiring 
operative treatment, as it was conveniently situated for recep- 
tion of cases disembarked in the Marsa Muscetto or Grand 
Harbours. There were three large barrack blocks of recent 
construction which could be converted into good hospital 
wards. The officers' mess and adjoining buildings were used 
as a home and hospital for nursing sisters. 

Tigne barracks became a non-dieted hospital for slightly 
wounded on the 2nd May, 1915. It was fully equipped as 
a dieted hospital of 600 beds in the following month. The 
number of beds was increased to 736 between November, 1915, 
and March, 1916, when they were again reduced to 600. In 
July, 1916, a further expansion took place by tentage to 
a maximum of 1,412 beds. The hospital was kept open till 
6th January, 1919. The barrack rooms were of modern 
construction and were well adapted for hospital purposes. 



MEDITERRANEAN GARRISONS 241 

The cases treated at Tigne at first were chiefly the slightly 
wounded, the site being an open, healthy one, well suited for 
rapid convalescence. 

The hospital at Ricasoli was opened in October, 1915, with 
800 beds, of which 224 were in the barrack rooms and 576 in 
tents on the parade ground. It was closed on the 19th 
February, 1916. 

A small special surgical hospital was opened in the Auberge 
de Baviere in June, 1915. It was an old building which had 
been used a.s the headquarters of the Command Paymaster 
shortly before the war, and previous to that as an officers' 
mess. It was conveniently situated in Valetta facing the 
Marsa Muscetto Harbour. The number of beds was 105, 
which were increased to 155 in August, 1915. The latter 
number was maintained until the hospital closed on the 14th 
August, 1917. It was used from the beginning as a hospital 
for severe surgical cases, and especially for the reception and 
treatment of surgical injuries of the head and spine. 

The hospital at Manoel was opened in November, 1915, 
in an old fort and in barrack huts and tents. It was equipped 
for 1,184 beds by December. In April, 1916, the accommo- 
dation was reduced to 100 beds, but had to be increased again 
in August, 1916, to 600, and in February, 1917, to 850. The 
hospital was closed on 2nd December, 1918. It was at first 
used for cases of scabies and was also available at any time 
as a military quarantine station.* It was, however, never 
necessary to use it for this latter purpose during the war, and 
it was used mainly as a hospital for ordinary sick. It was also 
used on various occasions for shipwrecked passengers and 
crews. The civil quarantine station was used as an officers' 
hospital of 80 beds. 

The third group of hospitals was in camps at St. David's, 
St. Patrick's, St. Paul's, and in a disused fort at Spinola, 
between Sliema and St. Julian's Bay. 

St. David's was a tented hospital for 1,000 beds situated 
near the St. Andrew's barracks. It was opened on the 25th 
July, 1915. In April, 1916, the beds were reduced to 400, 
but were increased again in July, 1916, to a maximum of 
1,168, and maintained at that number till the closing of the 
hospital at the beginning of May, 1917. 

The hospital at St. Patrick's in equipment and general 
features was similar to that at St. David's, but it was situated 

* Fort Manoel, which is a small island in the harbour of Marsa Muscetto, 
was connected by a bridge with the mainland at Sliema. It was used before 
the war as a hutted camp for troops, and, on the side facing Valetta, as the 
quarantine station of the civil government. 

(1735) R 



142 MEDICAL HISTORY OF THE WAR 

on terraced farm-land in the centre of the island. It opened 
with 1,000 beds on the 15th August, 1915, 54 beds were added 
in the following October, and it was reduced to 500 beds in 
April, 1916. It was again expanded in the following summer 
to 1,168, and eventually closed at the end of April, 1917. 
It was re-opened, however, with a maximum of 700 beds for 
a short period during June and July, 1917. A large farm- 
house on the site was used as a nursing sisters' mess and as 
store-rooms. 

The camp hospital at St. Paul's was formed of the huts sent 
out by the War Office. Two hundred and forty beds were 
ready at the end of August, 1915, and the full number, 792, 
in November. A slight reduction was made in April, 1916, 
followed by a maximum expansion in the following August 
to 898. The hospital was closed at the end of April, 1917. 

Spinola was a disused fort, but the hospital opened there 
was under canvas, on the glacis, the fort buildings being used 
for stores and administrative purposes. One thousand beds 
were ready early in November, 1915, but they were not 
actually used till January, 1916, and then for 169 patients 
only. It was closed in the following March, but was re-opened 
with 300 beds in September and expanded to a maximum 
of 1,168 beds in October, 1916. This accommodation was 
maintained until the hospital closed at the end of April, 1917. 

The fourth group of hospitals was in a small nursing home, 
known as the Blue Sisters ; in a technical school at Hamrun ; 
in the vacant Jesuit College of St. Ignatius ; and in civil 
government schools at St. Elmo and St. John's. The Blue 
Sisters' nursing home, maintained by the sisters of the Little 
Company of Mary, with the adjoining Clapp Zammit civil 
hospital, provided accommodation for 120 beds. The technical 
school at Hamrun was built two years before the war, but only 
the basement rooms had been occupied. It was opened in 
June, 1915, as a hospital under the British Red Cross Society 
with 106 beds, but became a military hospital of 80 beds for 
officers in November, 1915. It was closed in July, 1917. The 
St. Ignatius hospital was also equipped in June, 1915, and 
opened as a hospital for 155 beds. It was situated near 
Sliema and was used at first as a surgical hospital. It was 
reconstructed as a mental hospital in 1917, and finally closed 
in January, 1919. At St. Elmo two civil government schools 
overlooking the breakwater of the Grand Harbour were 
equipped with 318 hospital beds in August and September, 
1915, and were kept open as hospitals till the end of 1918. 
The maximum number of beds was 348 in August, 1916. They 
were used as a hospital for surgical cases. The civil school 



MEDITERRANEAN GARRISONS 243 

at St. John's outside Sliema was opened as a hospital for 400 
beds in September, 1915, increased to 520 in September, 

1916, and finally closed in October, 1917. The school 
buildings had only recently been completed, and were well 
adapted for hospital purposes. Although admirably suited 
for surgical work, it had to be used mainly for medical 
cases, owing to the large number of the latter arriving in 
Malta. 

In addition to these groups of hospitals, convalescent 
homes and depots were opened at Dragunara, All Saints, 
Chain Tuffieha, Melleha, Verdala, and St. Antonio palaces 
in Malta, and at Fort Chambray in Gozo. Dragunara and 
Verdala Palace were used as homes for convalescent 
officers, the former in a villa near St. George's Bay 
lent by the Marchesa Scicluna, who generously provided 100 
monthly for its maintenance during a period of twelve months. 
It had 20 beds, was opened in May, 1915, and closed in August, 

1917. It was administered by the British Red Cross Society, 
which provided personnel and supplemented the financial 
assistance given by the Marchesa Scicluna. Verdala Palace 
had accommodation for 30 convalescent officers and was used 
from December, 1915, to April, 1916, only. St. Antonio 
Palace was maintained as a convalescent home for 50 or 
60 nurses from the 8th December, 1915, to 19th March, 1916. 

The convalescent depots at All Saints, Ghain Tuffieha, and 
Melleha were large tented camps. The camp at All Saints 
was opened in June, 1915, for 1,600, but was reduced to 800 
from April to June, 1916. It was then greatly expanded. 
In October, 1916, it accommodated 2,650 convalescents and 
3,100 in July of the following year. It was finally closed in 
November, 1917. This large expansion was effected by 
forming a new camp for men who were considered fit for service 
but were waiting a passage. Strictly speaking they were no 
longer convalescents, although they were under medical charge. 
The site of All Saints was on high ground near St. Andrew's 
barracks and the camp and hospitals of St. Paul's and St. 
David's overlooking the Pembroke rifle range. 

The Ghain Tuffieha Camp was opened in August, 1915, 
with accommodation for 3,000, increased in January, 1916, to 
3,791. It was closed in January, 1919. It was about 10 miles 
distant from Valetta, on the southern coast of the west 
promontory of the island, and had been used as a summer 
camp in time of peace on account of its bathing facilities and 
cool breezes. For a short period immediately preceding and 
following the Armistice this convalescent camp was expanded 
to 5,000 beds in order to provide accommodation for the 

(1735) R 2 



244 MEDICAL HISTORY OF THE WAR 

large number of convalescents accumulating in the island 
pending evacuation to England. 

The Melleha convalescent depot was opened in February, 
1916 and closed in September, 1917. During the first six 
months its accommodation was for 1,250, but in September, 
1916, this was increased to 2,000 and maintained at that 
number till August, 1917. The site was that of a training 
camp in peace time, about 11 miles from Valetta on the 
northern coast of the west end of the island, where there were 
also ample facilities for bathing. 

The convalescent depot at Fort Chambray in Gozo was 
opened in the barracks there for 400 convalescents. It was 
originally opened in order to supplement the convalescent 
depot at All Saints, but owing to its isolated position it was 
closed in March, 1916, when additional accommodation was 
no longer required. 

The personnel required for the great expansion of hospital 
accommodation in Malta was obtained partly from local 
resources and partly from the United Kingdom. In April, 
1915, when the process of expansion commenced, the military 
medical personnel had been reduced to 9 officers, 14 nurses, 
and 220 other ranks of the R.A.M.C. Reinforcements from 
England did not arrive until the 7th May, 1915, and pending 
their arrival the services of 27 civil medical practitioners, 
11 nurses, and 65 men of the local St. John Ambulance 
Brigade, a body of men who had been highly trained for duty 
in connection with the Malta Defence Scheme and who had in 
the past taken part in the peace manoeuvres of the garrison, 
were obtained. A Scottish Women's hospital unit, consisting 
of 4 medical women, 38 fully trained nurses, and 20 members 
of a voluntary aid detachment, landed in Malta on the 4th 
May on its way to Serbia and voluntarily assisted in the 
hospitals there for a fortnight before re-embarking. They 
were distributed between the Valetta and Bighi Naval 
Hospitals, where most of the seriously wounded cases had been 
sent. Reinforcements of 82 medical officers, 219 nurses, and 
798 other ranks of the R.A.M.C. arrived during May, and by 
the end of September the medical personnel had increased 
to 240 officers, 567 nurses, and 1,760 other ranks. At the 
beginning of 1916 the medical personnel consisted of 334 
officers, 913 nurses, and 2,032 other ranks of the R.A.M.C. 
These numbers were considerably reduced in June, 1916, and 
during the remainder of the year the work was carried on by 
165 medical officers, 403 nurses, and 1,827 other ranks. In 
August, 1916, however, 42 qualified women doctors were sent 
to Malta and another reinforcement of women doctors arrived 



MEDITERRANEAN GARRISONS 245 

in November, bringing the number of medical women 
employed up to 76. Twenty-six local civil practitioners were also 
employed in the military hospitals. The rank and file of the 
R. A.M. C. were increased to a maximum of 2,378 in January, 1917. 

Consulting physicians and consulting surgeons* were appointed 
to Malta from time to time, as well as a consulting sanitary 
officer, a consulting anaesthetist, and specialists in surgery, 
bacteriology, ophthalmology, sanitation, dermatology, otology, 
mental diseases, and radiography. 

Colonel Sleman continued to act as D.D.M.S. of the Command 
until Malta began to expand into a great hospital base. 
Surgeon-General Whitehead was then sent from England as 
D.D.M.S., and arrived in July, 1915. On his transfer to 
Salonika he was succeeded in April, 1916, by Surgeon-General 
T. Yarr, who held the appointment during the remainder 
of the war period. 

The expansion of hospitals threw an enormous amount of 
work not only on the R.A.M.C. but also on the Royal Engineers 
and on Supply, Transport, and Ordnance Administrative 
Services. One of the great problems was water supply. The 
convalescent camp at All Saints, for example, had to be supplied 
at first with water carted laboriously from St. George's Barracks. 
A daily ration of one gallon per head only could be supplied 
in this way until tanks had been constructed. Fortunately 
the opportunities for sea bathing were good. The Royal 
Engineers, however, under Colonel Seaman solved all difficulties 
connected with water supply by increasing the storage capacity 
at Nadur, the waterworks of the main supply to the island. 
The Royal Engineers staff also completed in an incredibly 
short time the alterations and new works required to convert 
barracks, schools, and other buildings and camps into large 
hospitals. The resources of the island for this purpose were 
limited, but shortly after the war had commenced a prize ship 
was brought to Malta and provided a large quantity of joists, 
baths, water pipes, lead pipes, linoleum, and other articles 
which helped considerably to supplement the lack of material. 
The necessary works varied in the different hospitals, but in- 
cluded such services as the provision of sanitary annexes, 
ablution rooms and kitchens, the fitting up of operating 
theatres, X-ray rooms and dispensaries, the installation of 
electric light and gas for lighting and cooking, and the cleansing, 
colour-washing and painting of buildings. In camp hospitals 

* The consulting physicians were Colonel Purves Stewart and Colonel 
Gulland, followed later by Colonel Garrod and Colonel Tooth. The consulting 
surgeons were Colonel Barker, Colonel Ballance, Colonel Charters Symonds, 
and Colonel Thorburn. 



246 MEDICAL HISTORY OF THE WAR 

on rocky ground and on the glacis at Spinola much work had 
to be carried out to make the site suitable for tents and to fix 
tent pegs in concrete foundations. 

As regards food supplies for hospitals, the resources of the 
island could not be depended on to any great extent except 
for fresh vegetables and fruit. Eggs and chickens had to be 
shipped from Egypt, Tunis, and Italy. Milk was supplied 
in tins from England, and for a considerable time no reserves 
could be accumulated. 

Ambulance transport was an equally difficult problem at 
the beginning. There were one motor ambulance car, one 
motor car, one large tractor engine, and six tractors available 
at first, with a certain number of horse-drawn vehicles, but 
thirty private motor cars were placed at the disposal of the 
medical services until an efficient mechanical transport service 
could be established. In May, 1915, six Ford ambulance cars 
arrived ; in June twenty-four more and six motor lorries. 
An adequate transport service was then organized for the 
reception and distribution of the convoys of sick and wounded. 
The convoys were disembarked chiefly on the quay at the 
dockyard in the Grand Harbour, but ships were also unloaded 
in the Marsa Muscetto Harbour. 

Valuable voluntary help was given by the ladies in Malta, 
and by the Commissioners of the Joint War Committee of the 
British Red Cross Society and Order of St. John. At the 
suggestion of Lord Methuen a ladies' committee was formed 
to organize voluntary aid early in March, 1915. Another 
committee was formed in April under the auspices of the 
St. John Ambulance Association, and at the end of the month 
Captain Stockings arrived in Malta as Assistant Commissioner 
of the Joint War Committee of the British Red Cross Society 
and Order of St. John. Voluntary aid was then organized 
under Captain Stockings and other Commissioners of the Joint 
War Committee.* Ladies met each hospital ship, welcomed 
every sick and wounded soldier, and provided refreshment on 
landing. In hospital each patient was given a welcome parcel 
of tobacco, matches, and stationery. A large sewing party 
provided pyjamas, shirts, and socks. Voluntary nurses and 
orderlies were trained and gave much needed assistance. 
Voluntary workers corresponded with relatives at home and 
sent them information about men reported killed or missing, 
such as might be obtained from their comrades in hospital. 

* The Joint War Committee of the British Red Cross Society and Order 
of St. John also sent Mr. Tindal Robertson and Lieut. -Colonel Ashley as 
commissioners to Malta, and Sir Courtauld Thomson, the Chief Commissioner 
for the Mediterranean, frequently visited the island. 



247 

In 1916 invalid kitchens were opened in connection with the 
hospitals at Floriana, Valetta, Tigne, St. Andrew's, St. George's, 
and Imtarfa. They were also completed at St. David's and 
St. Patrick's, but never used owing to the closing of the hospitals 
in 1917. Another invalid kitchen came into use at the 
Cottonera Hospital. Many tea and recreation rooms were 
established, one which was especially useful being opened by 
Mrs. Bonavia and a band of helpers on the sea front at Sliema 
in the branch of the Union Club there, and consequently not 
far from the largest hospital centres in the neighbourhood of 
Sliema and St. George's Bay. Another useful institution of 
a similar character was organized by the committee of the 
Soldiers' and Sailors' Institute in the gymnasium at Valetta. 
The Australian Red Cross Society gave 2,000 for the erection 
of a fine stone building on a site between St. Andrew's and St. 
Paul's hospital. It was designed and constructed by the Royal 
Engineers, and was capable of seating 2,000. It was opened 
by H.E. The Governor, as the Australian Hall, in January, 
1916. Several other tea and recreation rooms were organized 
by Mr. Wilson and Mr. Tindall of the Y.M.C.A., the Scottish 
Church, the Church Army, and others. They proved of 
immense value in providing means of recreation to men, who 
would have otherwise drifted into the numberless drink shops, 
with which Malta abounds, and other undesirable localities. 

The medical and surgical stores and other hospital equipment 
were sent out with personnel from the United Kingdom, 
but a large number of beds with bedding were lent by private 
individuals at the beginning of the period of hospital expansion. 

The health of the garrison in Malta was good during the 
war. Although influenza became prevalent in June and July, 
1918, it was of a mild type and there was no mortality. It 
recrudesced, however, in a more severe form in the following 
months, and during September and October, 1918, there were 
3,079 cases with 59 deaths. With regard to other diseases, 
preventive measures were successful in keeping the military 
population free from such diseases as Mediterranean and 
enteric fever, which are more or less endemic amongst the 
civil population, and in keeping the civil population free from 
diseases, such as dysentery, which were being brought to the 
hospitals from the theatres of war.* 

The number of sick and wounded arriving in convoys up to 
February, 1919, was 2,538 officers, 14 nursing sisters, and 55,439 
other ranks, or a total of 57,991 from the Mediterranean 

* Lieut. -Colonel J. C. Robertson, I. M.S., acted as sanitary officer in the 
command until November, 1917. He was succeeded by Major G. R. Bruce, 
R.A.M.C. (S.R.) 



248 



MEDICAL HISTORY OF THE WAR 



Expeditionary Force, and 2,930 officers, 467 nursing sisters, 
and 74,733 other ranks, or a total of 78,130, from the Salonika 
Expeditionary Force. The highest number of patients in 
medical charge at any one time was 20,994 on the 23rd October, 
1916. Of these, 403 officers and 13,068 other ranks were under 
hospital treatment and 103 officers and 7,420 other ranks in 
convalescent depots, on light duty employments, or awaiting 
passage to return to their units. 

The demobilization of the temporary hospitals in Malta 
at the end of the war was carried out as expeditiously and 
smoothly as their mobilization. 

The following table shows the hospitals and convalescent 
depots opened at Malta during the war, with the dates of 
opening and closing. 



Designation. 


Date of 
opening. 


Number of 
beds on date 
of opening. 


Maximum 
expansion. 


Date of 
closing. 


Cottonera 


1 


167 


802 "1 




Imtarfa . . 
Forrest . . 


> Pre-war 


55 
20 


1,853 1 
186 f 


Post-war. 


Valetta . . 


J 


36 


524 J 




Tign6 


2/5/15 


600 


1,314 


6/1/19 


St. George's 


6/5/15 


840 


1,412 


31/10/17 


St. Andrew's 


9/5/15 


1,172 


1,258 


' 


fDragunara 


14/5/15 


12 


20 


29/8/17 


Floriana . . 


4/6/15 


600 


1,304 


30/4/17 


Blue Sisters 


6/6/15 


80 


120 


30/6/17 


Hamrun . . 


8/6/15 


108 


117 


5/7/17 


*A11 Saints 


12/6/15 


1,465 


2,000 


11/17 


Baviere . . 


15/6/15 


105 


155 


14/8/17 


St. Ignatius 


2/7/15 


155 


196 


? 


Sisters Hospital, 


10/7/15 


12 


31 


? 


Floriana 










St. David's 


25/7/15 


464 


1,168 


1/5/17 


St. Elmo . . 


12/8/15 


218 


348 


10/17 


St. Patrick's 


15/8/15 


1,000 


1,168 


27/4/17 


*Ghain Tuffieha 


15/8/15 


2,000 


5,000 


1/19 


St. Paul's 


25/8/15 


240 


898 


27/4/17 


St. John's 


1/9/15 


400 


520 


9/10/17 


*Fort Chambray 


4/10/15 


400 


400 


13/3/16 


Spinola 


6/11/15 


1,000 


1,168 


27/4/17 


Ricasoli 


6/11/15 


800 


800 


19/2/16 


Manoel 


16/11/15 


500 


1,184 


21/12/18 


fSan Antonio 


8/12/15 


50 


50 


19/3/16 


fVerdala 


9/12/15 


30 


30 


17/4/16 


*Melleha 


1/2/16 


1,250 


2,000 


5/9/17 



* Convalescent Depots. 



t Convalescent Homes. 



DM APRIL 1915 TO AUGUST (91 7 . 

? shaded portion ino/icstes vacant beds. From 
C/s up to february /9J9. 



1918 



1919 



DE.C JAN.IFEB MARIAPRIL MAY. (JUNE JULY. AUGT SEPT, OCT ' NOV 1 DEC. JAN! FEB 



~ t 




MEDITERRANEAN GARRISONS 249 

GIBRALTAR. 

In Gibraltar the medical arrangements for defence were 
mobilized and in working order on the 4th August, 1914. The 
hospital accommodation consisted of 160 beds in the military 
hospital and this could be supplemented, ,if necessary, by 
equipping, as hospitals, barracks which had been vacated by 
the troops. The R.A.M.C. personnel was 13 officers, including 
the quartermaster, and 86 other ranks. There were nine 
members of the Q.A.I.M.N.S. Colonel J. Maher was in 
administrative medical charge of the command as D.D.M.S. 
Various dressing stations were prepared at points previously 
arranged in accordance with the defence scheme. 

During 1914 conditions remained normal, but early in 1915 
the less important dressing stations were closed, ready to be 
reopened, however, should it be necessary to do so ; Colonel 
Maher was transferred to Egypt for duty, and Colonel H. H. 
Johnston took his place as D.D.M.S. 

The medical work then, so far as the war was concerned, 
consisted in preparing accommodation for, receiving, and 
treating sick and wounded from the Dardanelles. When 
Gallipoli was evacuated, sick and wounded ceased to arrive in 
Gibraltar, so that from January, 1916, onwards the medical 
work differed very little from the work in peace time. 

The maximum number of medical officers at any one time 
was 22, and of other ranks of the R.A.M.C. 180. The maxi- 
mum number of the nursing staff, including Q.A.I.M.N.S., 
Q.A.I.M.N.S. Reserve, and members of voluntary aid detach- 
ments was 55. 

Wounded first arrived in May, 1915, when seven Australians 
with very septic wounds were landed from the hospital ship 
" Letitia " on its way to England from Gallipoli. 

The military hospital was then expanded and equipped 
for 300 beds, and buildings were selected at Europa to form an 
overflow hospital ; but it was not till the following month 
that definite instructions were received from the War Office 
to provide accommodation for sick and wounded from the 
Dardanelles. 

Permanent barracks and hutments at Europa flats, which 
provided 338 beds in addition to the 300 at the military 
'lospital, were prepared, and in this way a general hospital of 
338 beds, including 14 for officers in a temporary military 
families' hospital, was organized. These preparations were 
completed by the 2nd July, 1915, and the first convoy arrived 
on the 6th August in the hospital ship " Somali." Thirty 
officers and 210 other ranks were disembarked then. 



250 MEDICAL HISTORY OF THE WAR 

Another convoy of 200 sick and wounded arrived in the 
" Asturias " on the 22nd August, and a third convoy of three 
officers and 28 other ranks in the hospital ship " Caledonia " 
on the 28th August. On the 30th August, 74 sick and 
wounded were transferred to the hospital ship "Ascania" 
for evacuation to the United Kingdom. 

In order to keep beds vacant at the general hospital, a con- 
valescent depot was formed in August, 1915, at Windmill Hill. 
It had accommodation for 579 convalescents and was kept 
open till June, 1916. 

Sick and wounded continued to arrive from the Dardanelles, 
and necessitated a still further increase of hospital accommo- 
dation. One hundred and sixty-two beds were obtained in 
September, 1915, in the Europa Pass Barracks and Windmill 
Hill flats, and 187 more in October, including 40 beds for 
officers in the Royal Artillery Mess at Bleak House, Europa. 
The maximum hospital accommodation in Gibraltar, amounting 
to 987 beds, was then reached. The hospital equipment was 
that of a stationary hospital, and at no time was it necessary 
to make use of tents. 

Convoys continued to arrive until the end of 1915. Eleven 
officers and 376 other ranks arrived on the 8th October, 
55 officers and 783 other ranks on the 15th October, 38 officers 
and 520 other ranks on the 8th November, and 690 other 
ranks on the 12th December. All these arrived in hospital 
ships with the exception of the convoy on the 15th October, 
which was landed from the ambulance transport "Caledonia." 
One hundred and thirteen of this convoy were sent direct to 
the convalescent depot, and 200 were taken over by the 
Royal Naval Hospital. The majority of the cases were cases 
of dysentery, diarrhoea, and debility. 

The convoy which arrived in December consisted chiefly 
of cases of frostbite. 

When sick and wounded were sufficiently convalescent they 
were transferred by ambulance transport for passage to England, 
those who were fit for duty rejoining their depot units. 

The distance from the landing wharf to the hospital was 
about one mile and mainly uphill. The available ambulance 
vehicles consisted of six ambulance wagons, two ambulance 
carts, thirteen Ashford litters, and sixty rubber-tyred wheel 
stretcher carriers. There were no motor ambulance cars, but 
private motor cars and local vehicles were used for less severe 
cases. Stretcher parties were supplied by the infantry 
battalions. 

In January, 1916, as convoys were no longer expected, the 
temporary hospitals at Europa and Windmill Hill were closed 



MEDITERRANEAN GARRISONS 251 

and the beds reduced to 395. They were still further reduced 
to 241 in August of that year. 

The only other event of interest affecting the medical 
services in Gibraltar during the war was the landing of 
270 survivors of the hospital ship " Dover Castle," which had 
been torpedoed in the Mediterranean in May, 1917. They 
were brought to Gibraltar in the hospital ship " Karapara." 

The health of the garrison was good, but the troops suffered, 
equally with the civil and naval population, from the epidemic 
of influenza in 1918, which commenced in Gibraltar in June 
and continued till December of that year. 



CHAPTER XIV 

THE MEDICAL SERVICES IN BERMUDA, JAMAICA, AND 
MAURITIUS 

AS regards the West Indian Garrisons, the conditions 
differed only to a very small degree from the conditions 
which existed before the war ; but regular R.A.M.C. personnel, 
as in the case of most of the garrisons abroad, were withdrawn 
for active operations elsewhere, and had to be replaced from 
local sources. 

At no time during the war was there any hostile activity in 
or around the West Indian garrisons. Many changes, however, 
took place in the military forces and administration as a direct 
result of the war. 

BERMUDA. 

In Bermuda the garrison in 1914 had a strength of 1,274 
officers and men, consisting of one battalion of British infantry, 
two companies of Garrison Artillery, one company of Royal 
Engineers, and details of the administrative services, including 
the 25th Company of the Royal Army Medical Corps. In 
addition to the regular troops there were two local Corps, the 
Bermuda Volunteer Rifle Corps, and the Bermuda Militia 
Garrison Artillery, the latter being composed of coloured troops. 

The R.A.M.C. consisted of 7 officers and 25 other ranks. 
There were two specialist officers, one for surgery and the other 
for sanitation. There were three hospitals, a central hospital 
of 30 beds at Prospect, the command headquarters, a non- 
dieted hospital of 12 beds at St. George's, and a four-bedded 
non-dieted hospital at Boaz. The hospital at St. George's 
was, however, originally a large hospital and could accommodate 
100 patients. There was an army medical stores at Watford 
near the naval dockyard, and a district laboratory near the 
central hospital at Prospect. A senior medical officer, with 
the rank of lieutenant-colonel, administered the military medical 
services. 

From the point of view of safety from attack the central 
hospital at Prospect was well situated. The hospital at St. 
George's had the advantage of being situated near the water's 
edge, but was exposed to attack, and to reach it from the 
landing stage, to which wounded from outlying posts might 



WEST INDIAN GARRISONS 253 

be brought, a steep hill had to be climbed. The mobilization 
scheme consequently provided for taking over as a hospital an 
establishment in St. George's known as Somers Inn. It was 
well situated for the reception of wounded from the landing 
stage, but had the inherent defects of narrow staircases and 
small rooms. Consequently, although it was actually taken 
over at the beginning of the war and equipped as a hospital, 
it was abandoned in less than a month and the original 
hospital at St. George's re-occupied. 

In September, 1914, the battalion of British infantry was 
withdrawn and replaced by a battalion of the Royal Canadian 
Rifles, which in its turn was relieved in August, 1915, by the 
38th Canadian battalion of the Canadian Expeditionary Force. 
In May, 1916, this battalion was replaced by the 163rd Canadian 
battalion, and it, in its turn, was relieved in November, 1916, 
by the second-line battalion of the 4th (T.F.) Battalion of the 
East Yorkshire Regiment. A battalion was sent also to 
Bermuda from Jamaica, the 3rd Battalion of the Jamaica 
War Contingent, and remained in Bermuda from the end of 
March till the 20th May, 1916. The Royal Garrison Artillery 
supplied drafts to artillery units in the theatres of war, and 
eventually the two companies were amalgamated into one. 

With regard to the R.A.M.C. personnel, all the regular 
R.A.M.C. officers except one, Major Ahern, who took over 
the duties of senior medical officer, left during the war. The 
surgical specialist and one of the officers, who was on leave 
when war broke out, were withdrawn from the command at 
once, and the others in September, 1915. The Canadian battalion 
and the Jamaica battalion, however, arrived with their own 
medical officers, although two of the Canadian medical 
officers had eventually to return to Canada. Local civil 
medical practitioners were consequently employed and 
certain adjustments made in the distribution of medical 
personnel. The sanitary officer, until he was withdrawn for 
service elsewhere in September, 1915, was transferred, together 
with the laboratory, to Watford on Boaz Island. This move 
was opposed by the civil medical officer of health at the time,, 
as it deprived him of the use of the military laboratory, which 
he had been privileged to use for his chemical and bacterio- 
logical examinations. Boaz Island, however, was in such an 
isolated position that no local civil practitioner could be sent 
there without separating him from his civil practice, and the 
sanitary officer's services were utilized there, not only for the 
laboratory work, but also for charge of the hospital and army 
medical stores. When he was withdrawn for active service 
in September, 1915, his duties were temporarily taken over by 



254 MEDICAL HISTORY OF THE WAR 

the senior naval medical officer on Ireland Island. The 
distribution of medical personnel then was as follows : The 
senior medical officer, R.A.M.C., the medical officer of the 
Canadian battalion, and one civil surgeon* were on duty at 
headquarters and in the hospital at Prospect ; two civil 
surgeons were employed at St. George's Hospital, and the 
senior naval medical officer, Ireland Island, acted as medical 
officer for the military garrison in Boaz Island and Ireland 
Island. In January, 1916, the medical officer of the Canadian 
battalion replaced the naval medical officer, and a second 
civilian practitioner was employed at Prospect. 

This medical personnel was considered excessive by the 
financial authorities for a garrison of 1,773, but the scattered 
distribution of the troops, the difficulty of communication, 
and the fact that, in the event of casualties suddenly being 
thrown upon them, there were no means of transferring sick 
and wounded elsewhere, justified a somewhat large medical 
establishment. 

This, in fact, occurred shortly afterwards, when in March, 
1916, the 3rd battalion of the Jamaica War Contingent arrived 
on board the s,s. " Verdalla." The vessel was proceeding from 
the West Indies to Halifax with the battalion when it en- 
countered a blizzard. The men, who were nearly all coloured 
and nearly all recruits, suffered so severely from the cold that 
the ship was ordered south to the warmer climate of Bermuda. 
On arrival there several hundred of the men in the battalion 
were found to be suffering from the effects of cold and frost- 
bite so severely that in ten cases amputations of toes or foot had 
to be performed, both feet having to be amputated in seven 
of the cases. The severe cases were admitted to the central 
hospital at Prospect. The St. George's Hospital was fully 
equipped and 87 of the cases sent there, while 19 more went 
to Watford hospital. The battalion was landed at Boaz Island 
and accommodated in tents and barracks, where 717 mild cases 
were treated as barrack hospital patients. There were also 
38 cases of pneumonia, seven of whom died. The battalion had 
landed with a strength of 28 officers and 1,088 other ranks. Of 
these latter 199 were returned to Jamaica unfit for further ser- 
vice. The battalion finally proceeded to Halifax in May, 1916. 

The influenza epidemic of 1918 attacked the troops in 
Bermuda in the middle of September, causing 484 admissions 
to hospital and nine deaths. The musketry camp at Warwick 
was opened as a convalescent depot for them. 

* Dr. W. E. Tucker, whose skill as a surgeon and untiring energy in 
all his work under the military authorities was specially praised by the 
Governor and Commander-in-Chief and by the senior medical officer. 



WEST INDIAN GARRISONS 255 

The incidence of other diseases, with the exception of 
venereal diseases, was small. There were only six admissions 
for enteric, twelve for pyrexia of uncertain origin and one for 
dysentery, during the whole of the war period. Venereal 
disease caused 359 admissions, almost entirely amongst the 
men of the Canadian battalions. 

With regard to sanitary work at Bermuda during the war, 
the outstanding feature was the completion in 1917 of a 
1,000,000 gallon tank for supplying water to the barracks at 
Prospect.* At no time was there actual shortage of food in 
the islands ; nor was it necessary to ration food supplies of 
the civil population. 

JAMAICA. 

The chief re-arrangement of medical services in the Jamaica 
garrison during the war was the concentration of all sick into 
the hospital at Up Park Camp and the closing of the hospitals 
at Port Royal and Newcastle. This arrangement was con- 
tinued until the return of invalids of the British West Indian 
Regiment, when the Port Royal hospital was again opened. 
Except for the arrival of these invalids from time to time, the 
work in Jamaica varied but little from the routine work 
previous to the war ; but the sick of troops from the United 
Kingdom likely to recover rapidly by change of air were in- 
valided at once to England, instead of being retained in the 
island. The strength of the garrison was maintained by men 
of low military category and to some extent by West Indian 
troops. The Jamaica Artillery Militia was embodied on the 
outbreak of war. 

The officers and most of the subordinate personnel of the 
R.A.M.C. were withdrawn. The former were replaced by civil 
practitioners and the latter partly by untrained men from home 
and partly by West Indians. The nursing duties were carried 
out by a staff of nurses trained locally. 

A standing camp for prisoners of war was formed at 
Swallowfield, the sanitation and water supply of which were 
the same as for Up Park Camp. There was very little sickness 
amongst the prisoners while in Jamaica. They were removed 
to Halifax in the spring of 1915. 

The sick and wounded of the Jamaica contingent and British 
West Indian Regiments, who were repatriated, had been many 
months in hospitals in France or elsewhere before returning 
to Jamaica. There was subsequently little left for the military 
medical services in the island to do with regard to them 

* The source of water supply in Bermuda is rain-water, collected on roofs 
of buildings or from catchment areas. 



256 MEDICAL HISTORY OF THE WAR 

beyond invaliding those who were unfit for further service, 
when they came under the care of the civil government and the 
district medical officers, with the right of treatment in the 
civil hospitals. 

At no time during the war was there any difficulty in 
Jamaica in obtaining sufficient supplies of food and medical 
and surgical material. 

MAURITIUS. 

The garrison of Mauritius practically ceased to exist during 
the war, and all R.A.M.C. and Q.A.I.M.N.S. personnel, with 
the exception of two staff-sergeants and three privates, were 
withdrawn, and the military medical services for the small 
garrison of less than 100 British troops were carried out by 
a local civil medical practitioner. The military and families' 
hospitals at Curepipe, and the Indian hospital at Port Louis 
were closed, and the only hospital accommodation maintained 
during the war was ten beds which were equipped temporarily 
in one of the barrack huts at Vacoas, subsequently expanded in 
January, 1917, by the addition of ten more beds, in another 
of the huts, for venereal and infectious diseases. 

During December, 1916, it was decided to mobilize a Mauri- 
tius Labour Corps for service in Mesopotamia, and a camp 
at Phoenix, adjoining Vacoas, which had been vacant for over 
a year, was taken into use as its depot. On the 9th May, 1917, 
the Corps, consisting of nine officers and 954 other ranks, left 
for Mesopotamia, and was subsequently reinforced by drafts 
from the depot. Officers and men belonging to it, who 
were invalided from Mesopotamia, returned to Mauritius in 
September and November, 1917, in February, May, and 
November, 1918, and in January and April, 1919. The first 
convoy consisted of one officer and 196 other ranks. The 
numbers subsequently arriving were small, the total, 
including the first convoy, being 226. After the Armistice 
in 1918 recruiting for the Corps ceased and all recruits then at 
the depot were demobilized, leaving a few details for adminis- 
trative purposes. There appears to have been comparatively 
little sickness amongst the recruits. A hospital for them was 
opened at first in the old hospital site at Phoenix Camp, 
but owing to the difficulty in obtaining medical personnel it 
was moved to a hut adjoining the hut used as a hospital for 
the European garrison in Vacoas, and placed under the super- 
vision of the R.A.M.C. personnel there. It was equipped for 
30 beds. 



CHAPTER XV 

THE MEDICAL SERVICES IN HONG KONG, THE STRAITS 
SETTLEMENTS, AND CEYLON 

THE garrisons in the Eastern Colonies, Ceylon, the Straits 
Settlements, and Hong Kong were menaced by attack 
from the considerable German naval force in the China Seas 
on the outbreak of war, as well as by the land force, some 
3,000 in all, which was garrisoning Tsingtau, although the 
chance of such attack was remote. 

HONG KONG. 

Hong Kong at the time war was declared had a garrison of 
some 6,090, consisting of three companies of Royal Garrison 
Artillery, one battalion of British infantry, four battalions 
of Indian infantry, an Indian Mountain Battery and Mule 
Corps Unit, together with details of R.E., A.S.C., R.A.M.C., 
and other administrative services. 

In September, 1914, the battalion of British infantry was 
withdrawn and replaced in April, 1915, by a T.F. battalion 
of the King's Shropshire Light Infantry. Tljree of the Indian 
battalions and the mountain battery were withdrawn in the 
early months of 1915, and replaced by one Indian battalion 
only. 

The R.A.M.C. establishment consisted of a Deputy Director 
of Medical Services, Colonel J. M. Irwin, in administrative 
charge, eight R.A.M.C. officers, including a quartermaster, 
four Indian Medical Service officers, one matron and seven 
other members of the Q.A.I.M.N.S., and a R.A.M.C. subor- 
dinate personnel. Most of these had been withdrawn by May, 
1915. At that time the strength of the garrison had been 
reduced to about half its peace strength, while the physique of 
the British troops was on the whole of a lower standard than 
that of those in the garrison before the war, as the troops who 
had been withdrawn were replaced by men fitted for garrison 
duty only. The medical personnel then consisted of two 
R.A.M.C. officers, two Indian Medical Service officers, and one 
retired medical officer of the Royal Horse Guards, who happened 
to be in the Far East at the time and volunteered for duty. 
Only two of the nursing sisters remained. 

The military hospitals on the island of Hong Kong and on 

257 
(1735) S 



258 MEDICAL HISTORY OF THE WAR 

the mainland at Kowloon were not subjected to any great 
changes in consequence of the war, except in so far as they had 
to be administered by a greatly diminished staff of medical 
officers and nurses. The number of equipped hospital beds, 
however, was reduced in proportion to the reduction in the 
garrison. The Q.A.I.M.N.S. nurses were finally withdrawn 
in 1917, and replaced by civilian nurses till the end of the 
"war. A women's voluntary aid detachment of the St. John 
Ambulance Brigade was formed in August, 1914, and trained 
in the military and civil hospitals. They were available for 
duty under the military authorities. Men's detachments were 
also formed at a later date and did duty with the Hong Kong 
Defence Corps. 

The governing body of the " Matilda " Hospital, a civil 
institution on a beautiful site at the top of the Peak, placed 
its beds at the disposal of the military authorities for patients 
in need of convalescent treatment. Advantage was freely taken 
of this, especially during the hot months. 

An ophthalmic specialist was appointed in 1917, Lieut. 
H. E. Murray, I. M.S. ; spectacles being obtained locally. 
Dentistry was carried out by a local dental practitioner. 

From the earliest days of the war a steady stream of men 
volunteered for active service, and special rooms were prepared 
for the medical examination of recruits at the military hospital. 
By the middle of June, 1918, 613 recruits were examined. In 
June, 1918, the Bill for Compulsory Military Service was passed 
in Hong Kong and all men called up were medically, examined 
before going before the military service tribunal ; 231 were 
thus examined in July, 1918, and 92 passed fit for service. 
This practically completed the recruiting work in the colony. 

The defence of Hong Kong entailed holding numerous out- 
posts by considerable forces, with whom the most rapid and 
in some cases the only means of personal communication was 
by water. Consequently as soon as these outposts were strongly 
held at the commencement of the war, a system of water 
convoys for the evacuation of the sick and their transfer to 
hospital was established. A special launch, provided with 
stretchers and medical equipment and comforts, was placed 
at the exclusive service of the medical authorities, and 
arrangements were made at the same time for medical officers 
or members of the Indian subordinate medical service to visit 
the outposts regularly and systematically. Special ambulance 
transport arrangements were also made for landing sick from 
the launch and conveying them to hospital. 

After the fall of Tsingtau in 1914 and the cessation of any 
definite menace from the German navy, the strength of the 



HONG KONG 259 

iorces holding the outposts was somewhat reduced, but remained 
considerably greater than during peace. Consequently a number 
of R.A.M.C. orderlies was regularly maintained at the outposts 
throughout the whole period of the war, with a view to 
reducing to the lowest possible limits the constant transfer to 
hospital of men who were in need of only slight medical atten- 
tion. This system proved so beneficial that it was continued 
as a permanent system after the war. 

The sick and wounded from the troops engaged in the 
operations at Tsingtau were brought to Hong Kong and treated 
in the military hospitals at Hong Kong and Kowloon. They 
included 26 cases from the South Wales Borderers, and 15 from 
the 36th Sikhs. But in addition to these wounded, a certain 
number of men suffering from remote effects of wounds during 
the war came under the care of the R.A.M.C. in Hong Kong. 
These were men who had been wounded while with other 
expeditionary forces and had been subsequently transferred 
to Hong Kong as fit for garrison duty only. 

A camp for interned civilians and prisoners of war was formed 
at the beginning of the war on Stonecutters' Island. The 
accommodation proved insufficient shortly afterwards' and a 
larger camp was formed at Hunghom on the mainland, where 
about 300 were accommodated during the greater part of 1915 ; 
their families being interned in British married quarters at 
Gun Club Hill. The camp was visited daily by a medical 
officer. Sick requiring hospital treatment were admitted to 
the military hospital, and sick women and children were sent 
when necessary to the civil hospitals. In January, 1916, all 
interned civilians and prisoners of war, together with their 
families, were sent to Australia. 

The general health of the Hong Kong garrison was remarkably 
good during the war. There was a severe outbreak of small-pox 
amongst the civil population in the winter of 1916-17 f , about 
1,223 cases being recorded, with a mortality of 75 per cent. 
In twelve weeks 332,000 Chinese were vaccinated, the rush of 
those applying for vaccination being great. The only case 
amongst the troops was a mild case in an officer who was 
much exposed to infection in connection with some civil duties 
he was performing, and who was not well protected by vac- 
cination. 

In the early months of 1918 cerebro-spinal fever, which had 
been practically unknown in the colony, made its appearance ; 
1,235 civil cases were reported during the first six months, and 
in the spring of 1919 there was some recrudescence of the 
disease, but the troops remained entirely free. 

Influenza, although always present to a considerable extent 

(1735) S2 



260 MEDICAL HISTORY OF THE WAR 

in China, did not visit Hong Kong during the war in the form 
of an epidemic of any great severity. 

There was never any scarcity of foodstuffs during the war, 
and no radical changes had to be made in respect of rationing 
and dieting in hospitals. 

STRAITS SETTLEMENTS. 

One British and one Indian battalion of infantry were 
stationed at Singapore on the outbreak of war, together with 
Garrison Artillery, Royal Engineers, and details of administra- 
tive services. On the 27th September, 1914, the British infantry 
battalion left for Europe, and was not replaced till the 23rd 
February, 1915, when the 4th (T.F.) Battalion of the King's 
Shropshire Light Infantry arrived from Rangoon, and remained 
in Singapore till April, 1917. The 25th Garrison Battalion 
of the Manchester Regiment had then just arrived from 
England and remained till July, 1918. It was replaced in 
August, 1918, by a wing of the 1st Garrison Battalion 
of the Manchester Regiment from India. The barracks at 
Tanglin were partly closed down and some of the duties 
were undertaken by local men of the Singapore Volunteer 
Corps. A camp had been formed in the grounds of the 
Tanglin Barracks for interned German civilians, and one of 
the duties of these volunteers was to guard the camp and the 
military hospital, which was kept open for the sick in the 
barracks. 

The Indian battalion was quartered in the Alexandra Barracks 
and had its own regimental hospital and battalion medical officer 
there. 

The British Garrison Artillery and Engineers were on the 
island of Blakan Mati, outside the harbour of Singapore and 
one of its sea defences. There was a military hospital on the 
island. 

The R.A.M.C. personnel on the outbreak of war consisted of a 
senior medical officer, Lieut.-Colonel J. D. Ferguson, a command 
sanitary officer, two officers and thirteen other ranks at the 
hospital at Tanglin, and two officers and eight other ranks 
at the hospital at Blakan Mati. All of these officers were 
withdrawn for active service from time to time in other theatres 
of war ; the last to leave being Major W. F. Christie in February, 
1916. Their duties were taken over by the officers and men 
of the Singapore Field Ambulance Company, a local volunteer 
unit, which mobilized immediately on the outbreak of war, and 
underwent a course of instruction in hospital duties and 
administration under the officers of the R.A.M.C. at the military 
hospitals. On completion of the course of instruction the 



STRAITS SETTLEMENTS 261 

company was demobilized until subsequent events led to its 
mobilization in February, 1915, for field operations and to 
replace R.A.M.C. personnel in the garrison. One of its officers, 
Major W. R. C. Middleton, was appointed command sanitary 
officer in May, 1915, on the withdrawal of the R.A.M.C. sanitary 
specialist, and he became the senior medical officer of the 
command when Major Christie left in 1916. After that date the 
medical and sanitary work of the garrison was carried out 
entirely by the Singapore Field Ambulance Company. All the 
officers of the company carried out their civil as well as their 
military duties during that time. Major Middleton left for 
England in January, 1917, and was succeeded as senior medical 
officer by Major N. Black, also of the Singapore Field Ambu- 
lance Company, until the return of regular R.A.M.C. officers 
during June and July, 1919. Two of the medical officers 
of the Company were appointed to commissions in the 
R.A.M.C., one being posted to France, and the other employed 
in anti-gas work at the R.A.M. College in London. 

The military hospitals in Singapore at the outbreak of war 
were the R.A.M.C. hospitals at Tanglin, Blakan Mati and Fort 
Canning, and the Indian regimental hospital in the Alexandra 
Barracks. The Tanglin hospital was equipped for 60 beds, 
which were increased to 170 on mobilization, and arrangements 
made for a still further increase if necessary by taking over 
an additional bungalow. Its establishment was reinforced by an 
officer and 12 men of the Singapore Field Ambulance Company. 
When the British infantry battalion left in September, 1914, 
the equipped beds were reduced to their original number and 
remained so till the end of the war. 

The hospital at Blakan Mati was equipped for 40 beds, and 
continued to receive European sick until October, 1915, when 
it was closed, all European sick being transferred to the hospital 
at Tanglin. 

The military hospital at Fort Canning was a small hospital 
for the Hong Kong Singapore Company of Garrison Artillery. 
It was definitely closed in February, 1915. 

During the absence of a British infantry battalion from 
Singapore a mutiny occurred in the Indian battalion* 
quartered in the Alexandra barracks. It broke out with 
startling suddenness on the afternoon of the 15th February, 
1915. Its effect on the medical services and the medical 
arrangements generally is described in a report by Major 
W. F. Christie, from which the following extracts are taken: 

* Fifth Light Infantry. This battalion was afterwards transferred to the 
expeditionary force under General Dobell operating in the Cameroons. 



262 MEDICAL HISTORY OF THE WAR 

" The mutineers seized the regimental ammunition, murdered 
some of their officers, and splitting up into parties each pro- 
ceeded in different directions. To kill the white man and spare 
the white woman appeared to be the order of the day. The 
regiment possessed its own regimental hospital (Lieutenant 
Morrison, I. M.S., being in charge), but the hospital fell out of 
action as soon as the insurrection occurred. The hospital at 
Tanglin was under the command of Major A. J. Williamson, 
R.A.M.C., and a few R.A.M.C. N.C.O.'s and men. It sur- 
vived the fate of the Alexandra Hospital by about an hour, 
A party of the Indians raided Tanglin, entering the hospital 
and driving the patients before them or killing them if they 
did not escape. .They then shot and scattered the German 
prisoner guard, and promptly liberated the Germans. The 
hospital staff displayed great resource and bravery in attending 
to the wounded and in remaining within the vicinity of their 
post, but the hospital as a refuge for the wounded was not 
a safe place for quite a long time to come. On the outlying 
island of Blakan Mati, the small military hospital, which was 
beautifully placed on a high point of the island, was normally 
a centre for the treatment of malaria amongst the R.G.A. and 
the R.E. who manned the forts. In the town itself, for the 
military barracks were all on the outskirts, was the Govern- 
ment hospital for military officers and civilians, and much 
medical material could be drawn upon from that source if it 
was required. In such a surprise attack upon the community, 
heavy initial losses were inevitable. Many civilians en- 
countered mutineers and were killed. The chief surgeon to 
the civil Government hospital fell an early victim. Soldiers 
returning to their posts of duty were seized and shot. Military 
headquarters established itself on the wharf belonging to 
the P. & O. Steamship Company. Here medical head- 
quarters were to be found, Lieut. -Colonel J. D. Ferguson, 
R.A.M.C., being senior medical officer, and Captain A. N. 
Fraser, R.A.M.C., sanitary officer. The Blakan Mati military 
hospital was obviously a good place to send the wounded to 
on account of safety, and was promptly increased to a hundred 
beds. An excellent steam launch was made available for the 
conveyance of patients, and an ambulance wagon drawn by 
two bullocks plied between the Blakan Mati pier and the 
hospital. A medical aid post was established on the P. & O. 
wharf under Major Middleton, Singapore Volunteer Medical 
Corps, who superintended the embarkation. The very 
seriously wounded, unfit to stand the journey to Blakan Mati, 
were sent to the civil hospital in the town. Every available 
rifle was required to oppose the mutineers. The R.G.A. 



STRAITS SETTLEMENTS 263 

and the R.E. left their sea defences, accompanied by Lieut. 
A. Legge, Singapore Volunteer Medical Corps. The naval 
ratings from a small naval sloop, H.M.S. " Cadmus," in the 
harbour, left their ship with their doctor, Surgeon-Lieutenant 
Ferguson, R.N. The Singapore Volunteer Corps marched 
out with Lieutenant Hunter and Captain R. Keith, S.V.M.C., 
and numerous offers of medical help were forthcoming from 
civilian practitioners. Desultory firing continued all that 
night, but the casualties were few. Lieutenant Legge, 
S.V.M.C., was mortally wounded and died in the civil hospital 
practically on admission. With daybreak commenced the 
attack on Alexandra Barracks where the mutineers had spent 
the night. The fighting was all with the ordinary service 
rifle. There was throughout no shelling, no hand grenades, 
no bayoneting. Some of the ammunition in the possession 
of the mutineers was practice ammunition and effects were 
less severe ; but the range was short, especially when the 
British got in amongst the buildings of the barracks. The 
first batch of wounded arrived at Blakan Mati about 10 a.m. 
They stood the journey by boat and bullock ambulance cart 
well. Major A. J. Williamson, R.A.M.C., a surgical specialist, 
was sent to the hospital to superintend their surgical treatment. 
The larger proportion of the wounds were flesh wounds, and 
these healed up with great rapidity and seldom suppurated. 
The men generally were in good physical condition because the 
climate is such that regular exercise (tennis, football, swimming, 
cricket, etc.) is practised all the year round, Singapore having 
no seasonal variation. Some were malaria subjects, but few 
attacks of malaria were superimposed. There were no virulent 
infections, no gas gangrene, no tetanus, no septicaemia or 
pyaemia, and while the extensive wounds (particularly com- 
pound fractures) suppurated, the general infection was not 
severe. The recognized pre-war method of treating gun- 
shot injuries was followed, antiseptic dressings, drainage, 
and splinting being employed. It is well known that 
suppurative conditions are extremely difficult to treat in 
a tropical country like Singapore, and several of these cases 
were evacuated to England as soon as possible. The only 
case which died after reaching Blakan Mati was one shot in 
the lumbar region of the spine and was hopeless from the first. 
After the British troops had driven the mutineers from their 
barracks and liberated some British officers and men who had 
been at bay all night in one of the bungalows there, fewer 
wounded arrived at the hospital. The strain amongst all 
ranks had been great, and the unfit began to fall out. Malaria 
and physical exhaustion combined were responsible for the 



264 MEDICAL HISTORY OF THE WAR 

bulk of the sick. After the third day, the numbers of sick 
admitted outnumbered the wounded. With the addition 
of fresh British troops (4th K. S.L.I, and naval ratings) the 
mutineers scattered, and in the jungle chase which followed 
quite a number of men contracted malaria. The rounding 
up of mutineers lasted many weeks. As their forces weakened, 
so the mutineers threw away their rifles, and shooting except 
by the most desperate amongst them was abandoned." 

During the mutiny and the subsequent field operations 
against the mutineers detachments of French, Russian and 
Japanese troops arrived in Singapore, as well as the British 
territorial force battalion from Rangoon. The hospital at 
Tanglin then became the base hospital for the reception of 
their sick and wounded, as well as for those of the Royal Navy 
and Marines, from amongst whom there were 603 admissions 
and seven deaths, including a death from wounds during the 
mutiny. 

Ten of the volunteers defending the Tanglin barracks were 
killed and several wounded. Two of the interned German 
civilians were also accidentally wounded, one of them 
dying of his wounds. Three of the British regular troops 
were killed by multiple bullet wounds and several were 
wounded. 

The sick of the interned Germans quartered in Tanglin 
barracks were treated in a small bungalow converted into 
a hospital. About 300 were interned from October, 1914, until 
they were removed to Australia in April, 1915. 

After the mutiny was quelled the conditions as regards 
medical services resumed normal peace conditions, with the 
exception of the changes already noted in medical personnel 
and hospital accommodation. 

The health of the garrison was good ; a remarkable diminu- 
tion occurring year by year during the war in the admissions 
for malaria, as a result of the anti-malarial measures which 
had been initiated before the war, continued throughout the 
war, and practically completed by the end of 1917. The 
admissions year by year for malaria are from this point of view 
instructive. They were 163 and 94 in 1912 and 1913 respec- 
tively. In 1914 they fell to 48, no doubt due to reduction in 
the British garrison, as in 1915 they rose to 87, when a new 
British battalion joined the garrison. But in 1916 and 1917 
the admissions fell to 23 and 26, and in 1918 there were no 
admissions for malaria. Only 16 of the admissions in 1916 
and 14 in 1917 were fresh cases, the others being re-admissions. 
Several of the cases of malaria were transferred to Ceylon for 
convalescent treatment. 



CEYLON 265 

The " Dilwara " arrived at Singapore in November, and the 
" Duneera " in December, 1918, from India with troops for 
Vladivostock. Both vessels had a large number of influenza 
cases on board, who were landed at Singapore. The slighter 
cases were treated in a bungalow converted into a hospital, 
and the more severe cases in the Tanglin Hospital. With this 
exception there was no special incident of importance affecting 
the health of the garrison. 

CEYLON. 

The chief feature connected with the medical services in 
Ceylon during the war was the arrival there of transports 
containing British, Indian, Australian, and New Zealand troops, 
whose sick and infectious cases were landed in the island and 
left in charge of the military medical officers. On the out- 
break of war the R.A.M.C. personnel in Ceylon consisted of 
three officers and 23 other ranks. Two of the officers and 
eight other ranks left the command in October, 1914. The 
officers were replaced by two R.A.M.C. Special Reserve officers 
who were called up for duty. In January, 1916, the remaining 
R.A.M.C. regular officer was withdrawn and the strength reduced 
to one Special Reserve officer and three other ranks. The 
medical services were then reinforced by the Ceylon Medical 
Corps, which had opened a tented hospital for treatment of the 
personnel of the Ceylon Defence Force in a camp on the Rifle 
Green, Colombo, and which was eventually transferred to the 
military hospital, Colombo, where it continued to work till 
August, 1919. 

A camp for prisoners of war was opened at Diyatalawa with 
one of the Special Reserve officers in medical charge. On the 
15th November, 1914, eight British and 46 German casualties 
from the naval action between the " Sydney " and " Emden " 
were landed at Colombo, and transferred to the military 
hospital there. No deaths occurred and the cases were 
eventually discharged to duty or to the prisoners of war camp. 

The subsequent medical history of the Ceylon Command 
during the war consisted mainly of dealing with cases of 
infectious diseases occurring on transports. Haemorrhagic 
measles, cerebro-spinal meningitis, mumps, and influenza were 
the most frequent of these. In consequence of outbreaks of 
disease on board ship, troops had to be landed during the 
disinfection of the ship and its equipment. Five hundred 
to 800 men were landed for periods varying from two to fourteen 
days on several occasions, and at one time 2,000 troops were 
accommodated in camp for about fourteen days while the ship 
carrying them went into dock. In order to deal with their 



266 MEDICAL HISTORY OF THE WAR 

sick a building was obtained on loan from the Colombo Munici- 
pal Council as a hospital and answered all requirements. Owing 
to this influx of naval and military patients from outside the 
Command the number of admissions to the military hospital 
in Colombo rose from 198 in 1915 to 980 in 1918.* 

The troops belonging to the garrison were exceptionally free 
from disease, in spite of the fact that many of the European 
troops were kept for longer periods in Ceylon than their normal 
tour and an increase of neurasthenia of varying degrees was 
noticeable. Influenza visited the island during September and 
October, 1918, and although about two-thirds of the local 
troops of the Ceylon Light Infantry suffered very few cases 
occurred amongst the European troops. The senior medical 
officer notes that " the simple measures of daily sprinkling 
floors with cfesol, and the use of a lysol gargle had a marked 
effect in checking the occurrence of the disease." 

In 1917 and 1918 a large number of officers were sent to 
Ceylon on leave from Mesopotamia. Special arrangements 
were made for their treatment by the civil government medical 
officer at Nuwara Eliya. 

In May, 1918, all the Europeans of military age, numbering 
1,142, were examined for categorization as to their fitness for 
military service. 

With regard to sanitary measures in the island, there appears 
to have been a certain amount of friction in the Diyatalawa 
area, owing to three sanitary interests, naval, military and 
civil, acting independently with different sanitary arrangements. 

* The following is a diary of the work thrown on the local military services 
from outside the garrison : 

" 29/4/16 Forty-six cases of haemorrhagic measles ex Australian transport 

transferred to the military hospital. 
" 22/4/17 " Ingoma " landed 550 men who were camped on Rifle Green, 

" Yamen " landed 160 Chinese coolies. 

" 23/4/17540 K.S.L.I. camped on Rifle Green, re-embarked on 6/5/17. 
" 13/7/17 " A. 17 " landed 750 troops owing to outbreak of cerebro- 

spinal meningitis. These camped on Rifle Green, and an infectious 

disease hospital was opened. 
"24/7/17 "A.15" landed 280 patients. The officers' mess, Flagstaff, 

was opened as a hospital ; all embarked on 1/8/17. 
" 25/7/17 Forty-six Australian cerebro-spinal meningitis contacts were 

transferred to the military infectious disease hospital. 
" 7/8/17 " Empress of Britain " landed 70 British and 2,000 Indian 

troops, who were accommodated at Ragama till 17/8/17. 
" 6/12/17 An infectious disease hospital opened for mumps. 
" 25/9/18 31/10/18 Influenza epidemic : No. 5. Block Echelon barracks 

opened as hospital ; 1 36 patients under treatment. 
" 2/10/18 " Dilwara " landed 53 influenza patients. 
" 2/11/18. " Duneera " landed 17 influenza patients. 
"9/11/18 Eight hundred and thirty troops ex "Malta" landed and 

camped on Rifle Green, owing to outbreak of cerebro-spinal meningitis 

on board. The ship was disinfected and sailed on the 10/11/18." 



CEYLON 267 

An attempt was made to bring them under one sanitary 
control, but owing to lack of funds, it is said, the scheme was 
abandoned early in 1918. Invaluable assistance was obtained 
by the military medical authorities, however, from the civil 
authorities in the matter of disinfection, accommodation for 
infectious diseases, and specialist work when required. 



CHAPTER XVI 

THE MEDICAL SERVICES DURING THE OPERATIONS AGAINST 

TSINGTAU 

/ npHE North China Command had its headquarters in 
JL Tientsin. The British garrison consisted of a battalion of 
British Infantry the 2nd Battalion South Wales Borderers 
an Indian battalion the 36th Sikhs and details of adminis- 
trative services. It was commanded by Brigadier-General 
N. Barnardiston, his administrative medical officer at the 
time war was declared being Lieut. -Colonel C. J. Macdonald, 
R.A.M.C. 

On the 15th August, 1914, the Japanese Government had 
sent an ultimatum to the German Government demanding 
the unconditional surrender of Tsingtau, and stating that, 
unless an answer to that effect was received by the 23rd 
August, military operations would be undertaken. When it 
was decided that a British force should co-operate with the 
Japanese, an expeditionary force was organized at Tientsin, 
consisting of the 2nd Battalion South Wales Borderers, with 
detachments of the Army Service Corps, Royal Army Medical 
Corps, Army Ordnance Corps, Army Pay Corps, and Army 
Veterinary Service. This force left Tientsin, under General 
Barnardiston's command, on the 19th September, 1914. 

In the meantime a sea blockade of Tsingtau had been 
declared on the 27th August; 1914, and active operations on 
land had been commenced by the Japanese at the beginning 
of September. A large force of cavalry and infantry under 
Lieut. -General Kamio, composed chiefly of the 18th Division 
from Kyushu and supplemented by heavy artillery, landed on 
the 1st September at Lung-Kou, a small port on the north 
of the Shantung Peninsula at the southern entrance to the 
Gulf of Chili, opposite to and about 80 miles from Port 
Arthur. From there the force marched south to the 
German protected territory some 100 miles distant, through 
Lai-Chou-fu, Ping-tu, Chi-Mo-Hsien and Liu-ting, sending 
detachments west and south to Wei-Hsien and Kiao-Chau 
on the railway line between Tsingtau and Tsientin. The 
German sea and land protectorate, which extended radially 
from Tsingtau as a centre some 30 miles inland and seawards, 

268 



I2O 



OF OPERATIONS 
NST TSING-TAU. 




OPERATIONS AGAINST TSINGTAU 269 

had a frontier along the western and northern shores of the 
Kiao-Chau Bay and across the neck of land from the north- 
east corner of the bay to the shores of the Yellow Sea. 

The country enclosed by the land frontier was an area of 
precipitous and rugged mountains, intersected by rivers, 
valleys and nullahs on the east and north and more undulating 
country on the south and west. In its northern sector the Pai- 
sha-ho flows into the north-east corner of the Gulf of Kiao-Chau 
along the frontier line. In the middle sector the Li-tsun-ho and 
in the southern sector the Hai-po-ho also flow into the Gulf 
at distances of some 10 and 3 miles north of the town of 
Tsingtau respectively. 

Tsingtau itself was an attractive modern settlement, the 
construction of which was commenced by the Germans seventeen 
years before the war. It had become a favourite summer 
resort of Europeans in the Far East, and was able to produce 
a garrison of some 150 officers and 3,600 other ranks for its 
defence, including the German garrison at Tientsin which was 
moved to Tsingtau on the outbreak of war. The water supply 
of Tsingtau was obtained from waterworks at Li-tsun, with 
subsidiary works near the mouth of the Hai-po-ho. When 
these were captured water could only be obtained from wells 
in the town area. 

There were roads in the protected territory radiating in all 
directions from Li-tsun, a village in the centre of the area, 
but only two led across the frontier, one on the west to Liu- 
ting, and thence to various towns in Shantung and the other 
on the east, over the Ho-tung Pass to Wang-Ko-Chuang, on 
the Bay of Lao-Shan, and other places in the south of the 
Shantung Peninsula. Both these roads were connected up 
with Chi-Mo-Hsien, the principal Chinese town outside the 
frontier line, and about 10 miles distant from it. A road also 
ran along the railway line, which skirted the eastern shore 
of the Gulf of Kiao-Chau before turning westwards through 
Kiao-Chau. This road was also connected with Liu-ting and 
through it with Chi-Mo-Hsien. Many of the roads, however, 
were liable to become rivers of mud in wet weather, and 
were more of the nature of tracks than roads for heavy traffic. 

The country west of the Chi-Mo-Hsien Ping-tu road had 
suffered severely from recent floods, which had destroyed 
much of the railway line between Kiao-Chau and the frontier. 
With the exception, therefore, of a detachment of cavalry which 
proceeded to Kiao-Chau and from there patrolled the western 
shore of the Gulf, the Japanese main force marched against 
the Germans through the more hilly country from Ping-tu 
to Chi-Mo-Hsien, reaching the latter in the middle of September, 



270 MEDICAL HISTORY OF THE WAR 



Liu-ting on the frontier was reached on the 18th September, 
and, having secured the frontier line, the Japanese then 
changed their base from Lung-Kou to Wang-Ko-Chuang on 
the Lao-Shan Bay, and sent a column from there to enter 
the German territory on the north-east corner of its frontier 
over the Ho-tung Pass, some 4 or 5 miles from Wang-Ko- 
Chuang. A field railway was then constructed along the 
Wang-Ko-Chuang Chi-Mo-Hsien road and on to Liu-ting. 
It was subsequently extended as the Japanese advanced to 
Li-tsun. 

General Barnardiston's small force arrived in Lao-Shan 
Bay on the 22nd September and landed at the Wang-Ko- 
Chuang base on the following day. It marched to Chi-Mo- 
Hsien, a distance of 13 miles, on the 26th September, being 
greatly delayed by the difficulty of movement along the single 
narrow road which was in bad condition and congested by 
traffic. At Chi-Mo-Hsien an advanced supply depot was 
formed. On the 27th September the British force moved 
to Liu-ting, and on the 28th towards Li-tsun, bivouacking 
some 2| miles behind the Japanese line. The weather was 
wet and the roads became tracks of deep mud. 

During the first half of October the operations were against 
mobile German troops which were delaying the advance on 
Tsingtau, but by the middle of the month the enemy withdrew 
to a strongly fortified line extending from the mouth of the 
Hai-po-ho and southward across the Tsingtau promontory to 
the Yellow Sea. 

During the latter half of October a line of investment was 
occupied. The enemy lines were finally assaulted during the 
first week of November, and the town capitulated on the 7th 
of the month. 

The portion of the line assigned to the British troops was 
from Tashan along a line of some 600 yards eastwards. Two 
companies held the line at a time. The remainder of the force 
occupied shelters in nullahs at the village of Huang-Chia-Ying. 
On the 22nd October two double companies of the 36th Sikhs 
from Tientsin disembarked at Wang-Ko-Chuang and joined 
the British contingent in the line of investment. 

In the final assault the advance was made to successive 
positions between the 1st and 6th November. On the 4th 
November heavy artillery fire was directed on the British, 
during which several casualties occurred amongst the ranks of 
the South Wales Borderers and the 36th Sikhs. In the advance 
to the final position on the 5th November, the 36th Sikhs 
had only slight losses, but the South Wales Borderers lost 
eight N.C.O.'s and men killed and 24 wounded. 



, 






AGAINST TSINGTAU. 



IAN PROTECTORATE. 



of English Mi/es. 
j 



eference 

Investment, 
tectonate . 




YELLOW SEA 



Malby&Sons.Lith. 



OPERATIONS AGAINST TSINGTAU 271 

The medical services of the British force were under the 
administrative control of Major J. A. Hartigan, R.A.M.C., 
who accompanied General Barnardiston from Tientsin. On 
the way to Lao-Shan Bay arrangements were made with the 
naval authorities at Wei-Hai-Wei to establish a hospital base 
there in the sick quarters of the Royal Navy. 

The " Shenking " was also fitted out as a hospital ship at 
Wei-Hai-Wei by the Royal Navy for conveyance of sick and 
wounded to Wei-Hai-Wei. 

The hospital at Wei- Wei- Wei was organized by Fleet- 
Surgeon Clerk, R.N., for 200 beds. It had a naval establish- 
ment, but when the 36th Sikhs joined the force, a sub-assistant 
surgeon of the Indian Subordinate Medical Department was 
obtained from Hong Kong and attached to the Naval Hospital, 
together with a havildar and four ward orderlies of the 36th 
Sikhs regimental medical service. 

On arrival in Lao-Shan Bay, a small detention hospital was 
established at Wang-Ko-Chuang for the accommodation of 
sick and wounded sent from the front while awaiting embarka- 
tion on the hospital ship. It had three large marquees and 
maintained a supply of medical stores and comforts. Its 
personnel consisted of a civil surgeon* from Tientsin, one 
N.G.O. and one private of the R.A.M.C. It was originally 
intended that the civil surgeon should accompany convoys of 
sick and wounded on the " Shenking " when necessary. The 
voyage to Wei-Hai-Wei was some 200 miles, and the medical 
staff appointed to the hospital ship was one N.C.O. and 
one private of the R.A.M.C., but the ship's officers and 
staff, two Chinese cooks and fifteen Chinese servants assisted 
in the care of the patients. The " Shenking," however, only 
made one voyage, for soon after the British contingent had 
commenced operations a hospital carrier, " Delta," which 
subsequently became a hospital ship for duty in other theatres 
of war, arrived with a large staff of medical officers, nursing 
sisters, and male sick attendants. The " Delta " made three 
voyages with sick and wounded. 

The medical arrangements with the field force consisted of 
a regimental medical service and a composite field medical 
unit, organized from personnel and material available at 
Tientsin. For regimental medical duties an officer of the 
R.A.M.C., Captain G. H. Dive, was attached to the South 
Wales Borderers, and a regimental medical establishment con- 
sisting of an Indian Medical Service officer, Captain E. S. Goss, 



* Dr. L. D. Shaw, afterwards temporary Lieut. -Colonel Shaw, R.A.M.C. 



272 MEDICAL HISTORY OF THE WAR 

four Sikh ward orderlies and four Indian dhoolie bearers 
accompanied the detachment of the 36th Sikhs. 

The field medical unit was organized as a modified field 
ambulance with bearer and tent sections. Its equipment, 
personnel and transport had to depend upon the resources 
obtainable in Tientsin. The tent section had six 160 Ib. tents, 
ten camp beds and ten palliasses, with medical and surgical 
material, and a personnel of two officers, Major J. A. Hartigan 
and Captain A. E. B. Wood, and twelve other ranks R.A.M.C, 
The bearer section was formed of 55 Chinese coolies, engaged 
and specially trained for the purpose at Tientsin, with nine 
dandies and a reserve of eight field stretchers. The transport 
consisted of three ambulance tongas, six transport carts and 
one water-cart. 

The unit accompanied the force on its march to Li-tsun and 
at first opened at the village of Yang-Chia-Chuang about 
3 miles farther south. The camp, however, came under the 
enemv's artillery fire and the ambulance was withdrawn to 
Tsche-Tschia-hsia (Chi-chia-hsia), some 5 miles farther east, 
and out of the line of fire. It remained there till the capitu- 
lation of Tsingtau. Its accommodation during that time was 
increased, as opportunities occurred, to 28 hospital beds and 
60 palliasses. It became, in fact, the one British medical unit for 
treatment of sick and wounded. The situation was suitable 
and pleasant, sufficiently close to the troops in the field, and 
on the direct route from front to base. During the final 
operations it was sufficiently well equipped to provide a 
hospital bed for every case of any severity admitted 
to it. 

In arranging for the removal of sick and wounded from the 
front two main points had to be considered. Owing to the 
condition of the roads for about one mile from the outposts, 
dandies and carts could not be used. Consequently all 
wounded had to be removed on stretchers over that distance, 
and as the first part of the journey was exposed to the enemy's 
fire, and as, therefore, it might not always be advisable to send 
a patient back at once, it was necessary to make arrangements 
for the temporary accommodation of patients at the outposts. 
Consequently a large combined regimental aid post was formed 
of splinter-proof shelters in the nullahs at Huang-Chia-Ying 
capable of accommodating 40 to 45 cases lying down. The 
medical officers with the British and Indian battalions, and 
one N.C.O. and one cook of the R.A.M.C., with a supply of 
medical and surgical material and comforts, were posted to 
it. For the transport of wounded from the outposts to the 
regimental aid post there were available twelve regimental 



OPERATIONS AGAINST TSINGTAU 273 

stretcher squads and eight Chinese stretcher squads who 
carried the cases to an advanced dressing station. 

The latter was formed about a mile in rear of the regimental 
aid post. It had splinter-proof shelter for 30 men and was 
at the most advanced point to which wheeled transport could 
be taken with comparative safety. Its personnel consisted of 
one medical officer, one 'N.C.O. and two men R.A.M.C., with 
nine dandies and, when required, three tongas and eight 
carts. More of the latter were available if necessary. 

From the advanced dressing station to the field medical 
unit or main dressing station the more serious cases were 
carried in dandies, all other lying-down cases in carts and 
sitting-up cases in tongas. 

The arrangements worked very well, there was no delay in 
the journey, and even on the day when there was a large 
number of casualties it allowed ample time to get the wounds 
dressed and every patient cleansed and put comfortably to bed 
before dark. 

As the available ambulance transport was very limited, experi- 
ments had been made in Tientsin, previous to the departure 
of the expedition, to determine how far the Indian pattern 
transport cart could be used for the carriage of wounded. 
The bottom and sides were well padded with straw and covered 
with blankets or a tarpaulin. The width of the carts was 
not sufficient to carry two patients on stretchers, but was 
just sufficient for them on blankets, the rails on the side of 
the cart preventing lateral jolting. Patients were lifted on 
and off the carts on blankets without distress. 

The transport of sick and wounded from the main dressing 
station to Lao-Shan at first presented a somewhat difficult 
problem. It was not possible or desirable to send them by 
the ordinary line of communication which was through Liu- 
Ting and Chi-Mo-Hsien, as the journey would have taken 
three days and there were no hospitals on that line other than 
Japanese. Endeavours were made to have the hospital ship 
moved to Sha-Tzu-Kou Bay, 12 miles nearer, but this was 
not considered safe until the end of the operations, owing 
to mines. All patients had, therefore, to be sent by the Ho- 
tung Pass and, as the latter was not suitable for wheeled 
transport, dandies had to be used. The journey was a long 
one, 18 miles, but all the patients stood the journey well and 
suffered no ill-effects. A R.A.M.C. cook was always sent on 
ahead as far as " Mecklenburg House," a German sanatorium 
on the road to Ho-tung, to prepare tea and bovril for the 
patients there. To ensure that no unnecessary delay would 
occur on the journey, eight coolies were sent with each dandy, 

(1735) T 



274 



MEDICAL HISTORY OF THE WAR 



and nine if the patient was above average weight. These extra 
coolies were obtained locally and paid in Japanese war notes. 

All sick convoys to the base were accompanied by a medical 
officer and a nursing orderly. 

The general health of the troops was very good. The 
admissions to hospital for sickness were 156; 99 were dis- 
charged to duty, 56 were transferred to the hospital ship, and 
one died in hospital. 

The three most prevalent diseases were malaria (29 cases), 
catairhal enteritis (21 cases), and inflammation connective 
tissue of hands (7 cases). Of the 29 cases of malaria, 
23 occurred during the first month of the campaign. All the 
cases had a history of previous attacks in North China. Each 
man who suffered from the disease was kept under observation 
arid given quinine for three weeks after discharge from hospital. 
Some of the cases of enteritis were of a severe nature and 
required prolonged treatment in hospital. With the exception 
of two cases that were transferred to the hospital ship, all 
returned to duty. Major Hartigan attributed the attacks to the 
unusually cold and wet weather during the latter half of the 
campaign, and to a large amount of insoluble matter suspended 
in the water at the time. The cases of inflammation con- 
nective tissue of hands were all of a severe nature and were 
the result of blisters obtained during entrenching work. One 
man died in hospital from dysentery during the operations. 
The case was a very severe one from the beginning. One 
other case of the disease occurred about the same time. This 
was also of a severe nature and was followed by liver abscess. 
The patient was operated on and did well. He was transferred 
to the hospital carrier " Delta." 

The total battle casualties during the campaign were 12 
killed and 59 wounded, distributed as follows : 





Killed. 


Wounded. 


Officers*. 


O.K. 


Officers. 


O.K. 


2nd South Wales Borderers 




10 


2 


38 


36th Sikhs 





2 


3 


14 


Australian Intelligence Corps 
Army Service Corps 








1 


1 



Most of the wounds were caused either by shrapnel or shell 
fragments. Some were of an unusually severe nature, but in 
no case did gas gangrene intervene. Five operations were per- 
formed at the main dressing station : extraction of bullets 
(3), excision of glands (1), liver abscess (1). 



OPERATIONS AGAINST TSINGTAU 



275 



In addition to the above one circular amputation at the 
middle of arm was performed. The patient was an old Chinese 
woman aged 61 years. Her hand and wrist were blown off 
by a shell three days previously and gangrene had set in when 
she came to hospital. The wound healed by primary union 
and she returned to her home twelve days afterwards. 

Owing to the nature of the operations and the limited space 
at the disposal of the troops, satisfactory sanitary arrangements 
were often difficult to maintain. In almost all cases water was 
obtained from rivers or streams, which were specially liable to 
pollution from the large number of troops in the neighbourhood. 
After rain the water contained a large amount of sand which, 
as already mentioned, was a probable cause of diarrhoea. 
There was, however, an entire absence of enteric or other 
.allied fevers. A large proportion of the troops had been 
inoculated against enteric fever. Very good water discipline 
was maintained and tea was prepared for the men to carry in 
their water-bottles. Two portable Griffiths' water sterilizers 
were sent with the expeditionary force and provided a sufficient 
supply of sterilized water at all times. Though the use of 
these sterilizers was not practicable on the line of march, they 
were of the greatest value in the siege operations. No filter 
water-carts were available. 

The rations issued were excellent both in quantity and 
quality. 

Major Hartigan makes special mention of the unvarying 
kindness shown by the Japanese medical authorities, who on 
every available opportunity were ready to afford medical 
assistance to the British troops. Lieut. -Colonel lishima, the 
director of medical services of the Japanese Forces, was in 
close touch with him, and Major Hartigan's responsibilities 
were greatly lessened by the knowledge that Japanese medical 
assistance was always available if required, although it was 
never necessary to apply for it. 

Lieut. -Colonel lishima also gave Major Hartigan the following 
interesting statement of the Japanese casualties during the 
operations : 

Sickness. 





Officers. 


N.C.O.'s & Men. 


Total. 


Admis- 
sions. 


Deaths. 


Admis- 
sions. 


Deaths, 


Admis- 
sions. 


Deaths. 


Infectious diseases 
Other diseases 


1 
26 


1 


34 
7,221 


2 

25 


35 

7,247 


2 

26 



(1735) 



T2 



276 



MEDICAL HISTORY OF THE WAR 



The numbers shown under admissions do not include those 
cases which ended fatally. 

The infectious diseases were as follows : typhus fever (4), 
dysentery (33). 

Battle Casualties. 



Officers. 


N.C.O's and Men. 


Total. 


Killed. 


Wounded. 


Killed. 


Wounded. 


Killed. 


Wounded. 


15 


43 


427 


1,423 


442 


1.466 



Killed (442). 

Classification according to projectile : Shell wounds, 220 ; 
bullet wounds, 178 ; wounds from mine explosions, 8 ; other 
causes, 36. 

Classification according to seat of injury : Head, 142 ; 
face, 20 ; neck, 23 ; chest, 135 ; abdomen, 63 ; upper 
extremity, 7 ; lower extremity, 38 ; unknown, 14. 

Wounded (1,466). 

Classification according to projectile : Shell, 871 ; bullet, 
508; mine explosions, 31 ; bayonet, 20; other causes, 36. 

Classification according to seat of injury : Head, 154 ; face, 
198 ; neck, 23 ; chest, 128 ; abdomen, 80 ; upper extremity, 
430 ; lower extremity, 449 ; unknown, 4. 



CHAPTER XVII 

THE MEDICAL SERVICES IN WEST AFRICA AND DURING 
OPERATIONS IN TOGOLAND 

SIERRA LEONE 

SIERRA LEONE was the only station in the West African 
Colonies garrisoned by Imperial troops at the time war 
commenced. During the war period certain local changes were 
made in the hospital accommodation and medical personnel, 
but otherwise the medical services were chiefly concerned in 
mobilizing and equipping units for the Cameroon Expeditionary 
Force, and subsequently in important medical work connected 
with the concentration and embarkation of native carriers for 
the campaign in East Africa. Lieut. -Colonel Gerrard, R.A.M.C., 
was the senior medical officer. Two of the R.A.M.C. officers, 
Major Statham and Captain E. B. Booth, accompanied the 
expeditionary force to the Cameroons, the former as director 
of medical services of the force. The advent of the convoy 
system in 1916, with its concentration of naval vessels and 
transports, kept one officer of the R.A.M.C. busily employed 
as embarkation medical officer at Sierra Leone for the removal 
of sick from transports to hospitals, inspecting vessels, and 
supplying medical stores. 

Approximately 12,000 carriers for the expeditionary force 
in East Africa were concentrated at one time or another at 
Sierra Leone during this period of the war, and came under 
the charge of the medical staff. Infectious diseases from trans- 
ports were fairly numerous. On one occasion 14 cases of 
cerebro-spinal meningitis and 850 contacts were landed, and 
a serious epidemic of influenza broke out in August, 1918. 

The military hospitals at Sierra Leone before the war period 
were at Wilberforce, Tower Hill, and Mount Aureol. The Wilber- 
force hospital was not suitable for occupation when war com- 
menced, as it was in the fire zone of the defences ; and was 
consequently taken over for non-medical purposes. A hospital 
for the West African Regiment was provided in its place in 
barracks. The Tower Hill and Mount Aureol hospitals were 
capable of expansion to 150 beds by using verandahs, and the 
Garrison Club near the former could accommodate 30 more 

277 



278 MEDICAL HISTORY OF THE WAR 

if necessary. The barrack rooms at Tower Hill and Mount 
Aureol were also available for treatment of slighter cases fo 
sickness or injury, and auxiliary accommodation was to be 
found in civil hospitals. 

The medical personnel was always maintained at a strength 
of eight officers by appointing for duty on shore medical officers 
from transports from time to time to replace those on the sick 
list. The strength of orderlies was also maintained during 
periods of stress by obtaining assistance from transports. 
Much voluntary help was given by ladies of the garrison, three 
of whom had nursing qualifications. 

There were no specialist officers, but much organized sanitary 
work was carried out by forming sanitary areas with a medical 
officer and a bush-clearing gang of some 20 men in each, under 
the direct control of the senior medical officer. Malaria was 
the chief disease with which they had to contend, and not only 
were active measures taken to free the military area from 
mosquitoes, but the civil sanitary officer arranged for an 
inspector and two sanitary squads to clean up the neighbouring 
villages. Subsequently, in August, 1915, they were placed under 
military control. 

In 1917 the harbour throughout the year was usually 
crowded with warships, transports and other vessels. Numbers 
of soldiers and sailors from these were allowed to come on shore 
and contracted malaria. In February, 1918, a meeting of 
naval and military medical officers was held to consider the 
question of preventing this, and it was decided to appoint a 
naval medical officer to inspect all ships, other than transports, 
entering the harbour, to restrict shore leave, and to prohibit 
any persons from the ships remaining on shore after 6 p.m. 
Also a civil anti-malarial commission was appointed in 1918, and 
an anti-malarial scheme for the civil population and the town 
of Freetown was authorized. The importance of anti-malarial 
measures is emphasized by the large number of malaria cases 
which occurred in a small garrison of an average strength of 
some 300 during the war. 2,437 admissions with nine deaths 
were recorded during the whole period of the war. In fact, 
two-thirds of the total sickness in the garrison was caused by it. 

The influenza epidemic in August and September, 1918, caused 
135 admissions with 4 deaths amongst the European troops, 
and 1,171 admissions with 32 deaths amongst the West Africans 
in a very short period of prevalence ; 319 cases and 26 
deaths also occurred amongst cases landed from ships of the 
Royal Navy. Five barrack rooms at Mount Aureol with 
accommodation for 150 beds were allotted for their reception 
and a naval medical officer with 14 naval ratings placed in 



OPERATIONS IN TOGOLAND 279 

charge. At the time of the epidemic there was some difficulty 
in obtaining suitable articles of food such as eggs, chickens, and 
fruit ; but this was alleviated by Red Cross comforts and 
stores which were obtained by an appeal to some Australian 
transports then in harbour. An issue of rum and of \ Ib. fresh 
meat is said to have been beneficial, especially in the case of 
the native troops, in counteracting the effects of the epidemic. 

OPERATIONS IN TOGOLAND. 

An expeditionary force operated against the German colony 
of Togoland between the 7th and the 26th August, 1914. On 
the 12th and 13th August a base was formed at Lome, which 
had been evacuated by the Germans immediately after war 
was declared. The British force operating from this base was 
organized in the adjoining Gold Coast colony and consisted of 
16 European officers, 7 European non-commissioned officers, 
and 535 rank and file of the Gold Coast Regiment, with 2,000 
native carriers. It was joined on the 18th August by a detach- 
ment of French Senegalese troops composed of 3 European 
officers, 5 European non-commissioned officers, 150 native rank 
and file, and about 100 carriers. This Lome force was under 
the command of Lieut. -Colonel Bryant. A second British 
column operated from Krachi on the western frontier of 
Togoland, and a second French column under Major Maroix 
marched on Atakpame (Kamina) from Dahomey, while a third 
French column entered Togoland from the North. 

The force from Lome advanced on the 14th August, one 
company of the Gold Coast Regiment moving to Tsewie, and 
the remainder of the force to Togblekove. It came into touch 
with the enemy at the Lili river on the 14th and 15th August, 
and engaged in severe fighting at Agbalohoe, which fell into the 
hands of the British and gave them possession of the railway 
line for 30 miles farther north. 

After the French detachment had arrived the whole force 
was concentrated on the 20th August at Nuatja, and on the 
22nd August attacked a strongly entrenched position at the 
Chra river. The enemy force opposing Colonel Bryant's 
column was estimated at 60 Europeans and 400 native soldiers. 
Owing to their strongly entrenched position the casualties 
amongst them are said to have been few, but the British lost 
2 officers and 21 men killed and 2 officers and 48 men wounded, 
or 17 per cent, of the force engaged. The enemy withdrew from 
the Chra position without further fighting and surrendered 
unconditionally on the 26th August. Major Maroix's column 
reached Atakpame on the 27th August. By that time the other 



280 MEDICAL HISTORY OF THE WAR 

columns operating against Togoland had not come in touch 
with the main column from Lome. 

The British medical arrangements were organized entirely by 
the medical service of the Gold Coast Colony. Dr. W. W. 
Claridge, who accompanied the Gold Coast Regiment from 
Kumasi, was appointed senior medical officer of the force. He 
had with him a dispenser and a dresser. Another medical 
officer, Dr. Mugliston, came with the regiment from Obuasi, 
Dr. Condy and a sanitary inspector joined from Accra. Two 
other medical officers, Dr. d'Amico and Dr. May, were also 
attached to the force, and another medical officer, Dr. G. H. 
Le Fanu, was in Lome in advance of it, on the 7th of August. 
On the 18th August the deputy principal medical officer of 
the Gold Coast Colony, Dr. E. H. Tweedy, with one other 
medical officer, Dr. J. M. O'Brien, three dispensers and three 
dressers arrived at Lome from Accra, and took charge of the 
base there. One medical officer, Dr. W. Watt, and a dresser 
were with the Krachi column. 

A good German hospital existed at Lome and was taken over 
by Dr. Le Fanu when the Germans left. It was being recon- 
structed and the partially finished new buildings were rapidly 
prepared. The old buildings contained 7 beds for Europeans 
and 20 for natives, the new buildings 14 for Europeans and 
40 for natives, so that there were altogether 27 European 
and 54 native beds available. Four German nursing sisters 
and 27 others of the staff had been left behind and were retained 
for work in the hospital under Dr. Le Fanu. Two other sisters 
were subsequently added to the staff. 

The total number of sick and wounded admitted to the Lome 
hospital during this short campaign was 13 Europeans and 
53 natives, of whom 18 were French Senegalese. The number 
of admissions for wounds was 6 Europeans and 45 natives. 
Only one wounded case proved fatal, although the Germans had 
used soft-nosed and sporting ammunition, which caused wounds 
of a very severe character. 

The general health of the force was excellent, the admissions 
for sickness being for mild attacks of malaria, rheumatism, 
catarrhs, and blistered feet. 

The climate and general character of the country over which 
the operations took place were more favourable than during 
the subsequent operations in the Cameroons. The coastal 
region is comparatively dry with a mean annual rainfall of 
27 '56 in., while the rainfall in the interior is considerably 
higher, thus reversing the meteorological conditions which obtain 
in the Cameroons. August is a dry month in the coastal belt, 
but wet in the interior, the mean annual rainfall at Lome 



ERATIONS AGAINST TOGOLAND. 



AUGUST 1914. 



OF ENGLISH MILES. 

ip 20 3O 



o 

z 




-I 
o 
o 
o 
I- 



Malby &Sons.Lith. 



OPERATIONS IN TOGOLAND 281 

during August being only O08 in., as compared with 7'01 in. in 
Atakpame. The line of advance from Lome to Atakpame passed 
through a belt of oil palms and forest for the first 30 miles or so 
from Lome ; from there onwards it was more or less open bush 
country to Atakpame, which was at an elevation of 1,080 ft. 
above sea-level. 

The sanitary conditions at Lome and elsewhere were bad. 
There were no latrines, and it was only after energetic sanitary 
work that improvements were effected. Pit latrines were dug 
and refuse burned, but, at Lome, in the absence of latrines the 
men were marched at intervals to the sea. 

Temporary hospitals were formed at camps on the lines of 
communication, and evacuation of wounded from the Chra battle 
was effected comfortably and rapidly by means of an ambulance 
train, which was organized at the base and arrived at the Chra 
two days after the action. It had been fitted out with great 
rapidity both for lying-down and sitting-up cases, the Catholic 
mission at Lome helping greatly in equipping it. For the 
prisoners of war a detention hospital was prepared on a ship, 
and a German medical officer, Dr. Berger, placed in medical 
charge of it. 

The Gold Coast Regiment subsequently joined General 
DobelTs force for operations in the Cameroons. 



CHAPTER XVIII 

THE MEDICAL SERVICES DURING THE OPERATIONS IN THE 

CAMEROONS 



formation of an expeditionary force against the 
- Cameroons consisting of British and French troops 
under the command of Brigadier-General C. M. Dobell, the 
Inspector-General of the West African Frontier Force, was 
decided upon in August, 1914. Before its arrival, French 
columns from French Equatorial Africa had already attacked 
the German posts on the north-east and south of the Cameroons, 
while small British columns attacked posts on the Nigerian 
frontier at Mora, Garua, and Nsanakang. The British attacks 
were repulsed with a loss of about 150 officers and other ranks. 
These operations were followed on the 6th September by a 
strong German attack on a British detachment which had 
succeeded in occupying Nsanakang on the south-west corner of 
Nigeria. The British troops there lost 7 officers and 180 other 
ranks in killed, wounded, or captured, and were practically 
annihilated. 

General Dobell left England on the 31st August, with a 
small staff on the " Appam," a ship of 8,000 tons, and 
picked up troops, carriers, and stores at various ports on the 
coast of West Africa : 20 men at Gambia, 800 troops and 1,300 
carriers at Sierra Leone, 1 ,200 carriers at Accra on the Gold 
Coast, and at Lome 600 men of the troops which had already 
captured Togoland from the enemy. At Lagos, European 
volunteers were embarked and given commissions. Major Best, 
R.A.M.C., Special Reserve, who was an officer of the West 
African Medical Staff, and Principal Medical Officer, Southern 
Provinces, Nigeria, also joined the force at Lagos. Farther 
south, at Forcados and Calabar, two battalions of the Nigeria 
Regiment, W.A.F.F., and 1,500 carriers were added. This 
completed the British force. A French force of 2,267, 
including 54 European officers and 354 European other ranks, 
together with 1,000 carriers, under Colonel Mayer, sailed from 
Dakar to Sierra Leone and joined General DobelTs expeditionary 
force there. 

This allied force mustered in Cameroon Bay on the 23rd 
September, 1914, in about 20 ships. It consisted then of 
154 British officers, 81 British non-commissioned officers, and 

282 



OPERATIONS IN THE CAMEROON S 283 

2,460 British West African troops, 2,267 French, and 4,563 



30' E. OF GREENWICH 940 




-410 



4'0 



--3 a 50 



9 C SO' 

MaibyJcSons. Lith 



northern and eastern areas are high plateaux covered with 



154 British officers, 81 British non-commissioned officers, and 



OPERATIONS IN THE CAMEROONS 283 

2,460 British West African troops, 2,267 French, and 4,563 
carriers, in addition to some 2,500 ratings of the British and 
French navies. The objective was Duala, the commercial 
capital of the Cameroons, which lay 17 miles up the river 
from Cameroon Bay. 

Operations were commenced on the 26th September, 1914, 
and by means of a bombardment carried out by H. M.S. " Chal- 
lenger," which had forced its way through sunken wrecks and 
other obstacles to within 11,000 yards of the town, Duala 
surrendered on the 27th September, and became the base of 
the operations which General DobelTs force subsequently con- 
ducted in various directions until the capture of Jaunde, the 
new seat of the German Government in the interior, on the 
1st January, 1916. 

In addition to the operations of the main expeditionary force 
based on Duala, operations were also conducted by British and 
French columns based on posts in Nigeria and in French 
Equatorial Africa. A northern force of 3,250 British and 750 
French, under Brig. -General Cunliffe, advanced from Maidugari, 
Yola, and Ibi in Northern Nigeria, and Fort Lamy in French 
Equatorial Africa ; another column known as the Cross River 
Column entered the Cameroons from Ikom in Southern Nigeria ; 
while French columns composed of 3,270 French and Belgian 
troops, afterwards increased to 4,000, under General Aymerich, 
entered the Cameroons from east and south. All these columns 
converged on Jaunde with General Dobell's main or western 
force in January, 1916. After the occupation of Jaunde the 
Germans dispersed southwards towards the Spanish territory 
of Muni, and subsequent operations consisted of columns of 
British and French endeavouring to intercept them. By the 
middle of February, 1916, all the German forces had sur- 
rendered or been driven into the neutral territory and the 
conquest of the Cameroons was complete. 

The country over which the operations took place was of 
vast extent, covering some 306,000 square miles,with a greatest 
length of 800 miles and a greatest width of 600 miles. The 
coastal belt through which the Western force and to some 
extent the Cross River Column operated consisted of dense 
forest and tropical vegetation. Beyond the coastal belt to 
the north and centre of the Cameroons the country is open, 
grassy, or mountainous. The Cameroon Mountain rises 
abruptly from the sea to over 13,000 ft. in height a short 
distance north-west of Duala, and mountain ranges also run 
roughly from south to north along the Nigerian frontier, and 
from west to ep,st across the centre of the Cameroons. The 
northern and eastern areas are high plateaux covered with 



284 MEDICAL HISTORY OF THE WAR 

grass, which slope to the lowlands on the west, and with open 
forest and bush in some places. 

The rainfall is very heavy in the western coastal area, 
amounting to 120 to 240 in. annually ; with a humid and 
enervating mean temperature of 80 to 85 F. The wet season 
is from May to September. As the interior is approached the 
rainfall diminishes and in the northern area does not amount 
to more than 10 in. in the year. In the eastern area it 
averages 40 to 80 in. 

The western or coastal region, through which General 
Dobell's force advanced on Jaunde, was unhealthy, the eastern 
area less so, and the northern area practically as healthy for 
military operations as a European climate. 

There were two railways in the country, both running from 
Duala, one northwards to Nkongsamba a distance of some 
100 miles, and the other of similar length, known as the Midland 
Railway, westwards to Eseka in the direction of Jaunde ; 
but there were also light railways running northwards from 
Victoria and adjacent coastal posts along the eastern foot 
of the Cameroon Mountain for use in connection with the 
extensive cocoa plantations. 

Road communications were by bush tracks, but there was 
one good motor road from Kribi on the coast to Jaunde. Rivers 
from the west coast were navigable for short distances, 
those running from the eastern areas into the Congo were 
navigable for long distances, and in the northern areas the 
River Benue running into the Niger was navigable to the 
Cameroon frontier and to Garua. 

The medical services of the campaign were organized under 
unusual conditions, as the medical units of General Dobell's 
expeditionary force were hurriedly created at sea from the 
personnel picked up as he went down the coast. They were 
composed mainly of medical officers of the West African Medical 
Staff with a varied assortment of equipment. Major Statham, 
R.A.M.C., was appointed Director of Medical Services by 
General Dobell and given the temporary rank of Lieut. -Colonel. 
On reaching Duala he had with him two other R.A.M.C. 
officers, Captain Booth from Sierra Leone, and Major Best, 
Special Reserve, who, as noted above, was the Principal 
Medical Officer, Southern Provinces, Nigeria, from Lagos ; 
26 medical officers of the West African Medical Staff ; 6 nursing 
sisters, seconded from the service of the West African 
Colonies ; 4 non-commissioned officers, R.A.M.C., and 20 native 
dressers ; together with the medical staff of the French force 
which joined the expedition at Sierra Leone, consisting of 
4 medical officers and 6 European and 12 native infirmiers 




COUNTRY OUTSIDE COASTAL BELT. 




BUSH COUNTRY ALONG THE MIDLAND RAILWAY. 

To face page 284. 



OPERATIONS IN THE CAMEROONS 285 

organized as a regimental medical service and as a small field 
medical unit. 

Both British and French personnel were reinforced or re- 
placed from time to time, so that a total of 57 additional 
British medical officers and 13 French arrived during the 
campaign, while 39 British and 10 French left. The 
average strength of medical officers with General Dobell's 
columns was 35 British and 10 French, and at the end of the 
campaign the British personnel was 45 medical officers, 
6 nursing sisters, 18 R.A M.C. non-commissioned officers, 
6 Indian assistant surgeons, 20 colonial dressers, and 
100 locally employed and trained medical subordinates. 

Before disembarking Colonel Statham organized a field 
medical service out of the personnel and equipment at his 
disposal to suit the anticipated medical requirements of the 
campaign and a land attack on Duala from a base on the 
Dibamba Creek. He had arranged a regimental medical 
service for each battalion, composed of one medical officer 
and eight carriers with medical equipment, and one trained 
orderly and eight hammock bearers with four stretchers or 
hammocks with each company. Four sections of a field 
ambulance, each with a bearer or hammock division and a tent 
division, were also organized. The bearer division consisted of 
one medical officer, one R.A.M.C. non-commissioned officer, 
and 68 carriers for stretchers or hammocks, and the tent 
division of one medical officer, one dresser, and 24 carriers 
for medical stores and tentage. A medical officer was 
appointed to superintend convoys and evacuation to the 
advanced base on the transport " Appam " in Cameroon Bay, 
and from there to a hospital base at Calabar in Nigeria. The 
system of evacuation was for the regimental medical service 
to collect wounded to a regimental aid post ; the bearer 
divisions of the field ambulance sections transferred them to the 
tent divisions ; while the carriers bringing up supplies brought 
the sick and wounded to the base on their return journey. 
From there they were conveyed in barges to the " Appam." 

As Duala surrendered without land fighting this medical 
organization based on the " Appam " did not come into opera- 
tion, although it continued to be the means of evacuating 
sick and wounded until a hospital base was formed at Duala. 
Its general principles, however, remained the same, but it was 
modified to a considerable extent in order to make it more 
suitable for the subsequent bush warfare. A stretcher bearer 
corps of 200 natives, increased to 300 or more, was formed. 
They were given a special uniform, and were distributed as 
bearers to the battalions and field ambulance sections. 



286 MEDICAL HISTORY OF THE WAR 

In bush warfare as previously conducted there was with 
each company or section of artillery a medical establishment 
of one medical officer and 40 or 60 carriers with a medical 
and surgical equipment and comfort boxes, and a carrier 
equipment of ten hammocks. This system was inadmissible 
in the medical arrangements for the Cameroons as 30 medical 
officers would have been required for regimental service alone, 
in addition to 200 or 250 medical carriers with each battalion. 
There would thus have been much wastage of personnel and 
material when companies were not actively engaged. The 
system adopted by Colonel Statham was to attach a section 
of a field ambulance to each battalion, but to make it trans- 
ferable at need to assist other battalions in any action in 
which two or more battalions were together but only one 
engaged. It was thus to be regarded more as a column than 
as a regimental unit. Originally it was organized with three 
medical officers, one R.A.M.C. non-commissioned officer, two 
dressers, four to six trained native orderlies, and 132 carriers 
for stretchers, hammocks and equipment, but owing to the 
unsuitability and inexperience of the dressers arriving as 
reinforcements, and also to the necessity of economizing 
medical officers and making provision for the base and lines 
of communication and for a medical service with detached 
companies, the section of a field ambulance was altered to two 
medical officers, two R.A.M.C. non-commissioned officers and 
four to six trained orderlies, while the carrier strength was 
reduced to 32 or 48 stretcher bearers and 32 or 48 carriers for 
equipment. 

The general principle of this new organization for bush 
warfare was to split up a field ambulance section into four 
smaller groups, or equipments as they were called, each suitable 
for attaching to a company, under a medical officer or R.A.M.C. 
non-commissioned officer. The alternative strength of carriers 
was intended to meet the requirements of battalions having 
a varying number of companies as well as to provide a scale 
for a field ambulance section moving with a light or heavy 
equipment. An evacuating field ambulance section was 
organized at the same time to act as an independent field 
medical unit in echelon behind the sections with battalions. 

The intention was to employ the lightly equipped field 
ambulance sections with battalions in columns, to which an 
evacuating section was attached, and the heavily equipped 
with columns that had no evacuating section. 

The light equipment sections consisted of four sets of the 
following, each with a medical officer or R.A.M.C. non-com- 
missioned officer in charge : 




BASE HOSPITAL, DUALA. 



To Jace pagt 28?. 



OPERATIONS IN THE CAMEROONS 287 

1 Surgical pocket case and haversack. 

1 Box of drugs (chiefly " tabloids "). 

1 Surgical dressing box. 

1 Box of medical comforts such as milk, bovril, and 

brandy. 
1 Aluminium water carrier with a set of chlorine 

apparatus to sterilize water. 

1 Filter, if available. 

2 Loads of hammocks (one suitable for Europeans). 
1 Load of ground sheets and blankets. 

1 Load of lamps and cooking pots. 

Each set required eight carriers. The heavy equipment 
was the same but with the addition of two stretchers, four 
native hammocks and one European hammock, together with 
such other equipment as might be required. Each of the 
heavy equipment sets required 12 carriers. 

One trained orderly and eight uniformed stretcher bearers 
were attached to each infantry company or section of artillery. 
They formed part of the field ambulance section and carried 
out only technical duties with the company, such as sanitation 
and stretcher bearing under a medical officer or non-com- 
missioned officer of the section. 

The evacuating field ambulance section had a smaller 
personnel, namely, two medical officers, one non-commissioned 
officer and 48 carriers, but a larger equipment consisting of : 

2 Surgical dressing boxes and operating case. 
2 Medical field cases. 

2 Medical comfort boxes. 

2 Loads of blankets. 

2 Loads of lamps and cooking pots. 

2 Loads of water carriers, and sterilizing apparatus. 

4 Loads of light hammocks. 

4 Loads of European hammocks. 

2 Loads of stretchers. 

There were also with the evacuating section 20 spare carriers 
for carrying sick and wounded forward in the event of an 
advance taking place before the patients could be evacuated 
down the line ; but, as a rule, this was provided for by the 
supply carriers of the day, who would be attached to the 
evacuating section before proceeding on their return journey. 

Aid posts or bush hospitals were established as required 
along the line of communication. At one time or another 
there were as many as one hundred of these, and over 40,000 
sick and wounded, in addition to a vast number of out-patients, 
were treated in them. 



288 MEDICAL HISTORY OF THE WAR 

At railheads clearing hospital units were formed. During 
the greater part of the campaign they were established by 
evacuating field ambulance sections in small German hospitals 
found there. 

The transport "Appam" in Cameroon Bay was the first 
hospital established at the base. It was transformed into a 
hospital for 80 Europeans and 300 native sick and wounded, 
and proved of great service during the first month of the 
campaign. A hospital base was subsequently organized at 
Duala. When the Allied Forces entered the town they found 
no German hospitals open in it. There had been a European 
and native general hospital in the Bell Town division of Duala, 
and two smaller European hospitals and one native hospital 
in Aqua Town, its other division ; while a fifth hospital of 
thatched huts was situated in the new native quarters of 
Duala, called New Bell Town. All of these buildings had, how- 
ever, been gutted or pillaged before or immediately after the 
arrival of the expeditionary force. The equipment of the larger 
European and native hospitals had been removed by the 
Germans to a suburb of Duala called Deido, 4 miles north 
of the port, so as to be safe from shell-fire, and a war hospital 
had been established there. 

The building of the European General Hospital had been 
occupied at first by a large number of German prisoners of war, 
but a small portion of it was taken up and equipped with a few 
camp beds and field medical equipment in order to serve as 
a European hospital. The only hospital in which any native 
beds could be found the native railway hospital was 
equipped as a native hospital from such stores as could be 
brought up rapidly from the "Appam." The German war 
hospital established in two mission houses at Deido was 
visited by the Director of Medical Services the day after his 
arrival in Duala. As it was outside the allied outposts, it 
was decided to bring a portion of their equipment to Duala at 
once to re-equip the European and native general hospitals. 
There were, however, over 20 European and 80 native sick and 
wounded at the German war hospital, so that it took several 
days with the few carriers available to close the hospital, and 
remove the equipment and patients to Duala. 

Within ten days of the occupation there were three hospitals 
equipped and in working order : one of 12 beds for Europeans 
in the European hospital building, one of 70 for native troops in 
an adjoining building, and a third of 80 beds for carriers. Six 
weeks later these figures had been increased to 80 beds for 
Europeans, and 310 for native troops including carriers. Labora- 
tory, operating theatre and X-ray rooms were gradually 




HUTTED HOSPITAL, DUALA. 



To face page 289 



OPERATIONS IN THE CAMEROONS 289 

added, and the hospitals steadily increased till they formed 
an allied hospital of 1,500 beds with two European divisions, 
one for British and one for French, two divisions for the British 
native troops, and one for the French native troops, and 
a division for carriers. Besides this there was an auxiliary 
French hospital for 20 European and 400 native beds at Aqua 
Town, an Indian hospital for 50 beds at Bonaberi, on the 
opposite side of the river, and, later on, smaller French and 
British hospitals at other places in advance of the base. The 
numerous urgent cases among the civil population and the 
reopening of the large German cocoa plantations with their 
thousands of labourers necessitated the formation of a medical 
staff and hospitals to deal , separately with them. The small 
depot of medical stores brought ashore to meet urgent needs 
when the force landed grew into a large organization, with 
a special staff, and occupied several buildings. 

After the capture of Duala, the main force under General 
Dobell, consisting of British and French West African troops 
and officers and men of the Royal Navy and Royal Marine 
Light Infantry, formed several columns which operated in 
different directions. A French column captured Jaboma where 
the Midland Railway crosses the Dibamba Creek, 4 or 5 miles 
east of Duala, but its further advance was checked for the 
time being. A British column advanced up the Wuri river on 
Jabassi. After sustaining a serious check it eventually took 
Jabassi on the 14th October, 1914, and pushed out to Njamban. 
Three columns then operated against Edea, a station of the 
Midland Railway, one column advancing along the railway line 
from Japoma, another as an armed flotilla up the Sanaga 
River, and the third, or main column, up the Nyong to Dehane, 
some 20 miles south of Edea, and thence by land. Edea 
was occupied by these combined movements on the 26th of 
October, 1914. 

Progress against the enemy by columns operating along the 
northern line of railway was continued ; operations were also 
carried out from Duala with the object of securing Buea, the 
hill station on the Cameroon Mountain, and the adjoining 
country including the coast town of Victoria. A naval force 
moved by sea to Victoria, a second force went by sea to Tiko and 
thence by land, while a third operated westwards against Buea 
from the railway line at Susa. Their objectives were secured 
by the 15th of November, 1914. 

With the occupation of Buea a convalescent depot was 
established in the German settlement which is situated some 
3,000 ft. above sea-level. Fresh milk and vegetables were 
obtainable there, but the climate was very damp and misty 

1735) U 



290 MEDICAL HISTORY OF THE WAR 

during the greater part of the year, and not very suitable for 
the purposes of a sanatorium. 

Operations were then conducted to clear the whole of the 
northern railway, and the country north of its railhead. The 
railhead, Nkongsamba, was occupied on the 10th December, 
1914, and the force pushed on northwards to the German 
fortified post of Dschang, but withdrew to railhead and its 
outpost Bare, after razing Dschang to the ground. 

The situation of the main force based on Duala at the 
beginning of 1915 was that British troops held the line of the 
Northern Railway and Bare, the coast town of Victoria, and 
a defended post, Dibombe, south-west of Jabassi ; and French 
troops the line of the Midland Railway as far as Edea, with 
a detachment on the coast at Kribi. 

At the same time columns were operating against the Came- 
roons from Nigeria and French Equatorial Africa. The force 
of French and Belgians under General Aymerich was moving 
from the east and south in the direction of Jaunde towards 
the end of 1914, but at that time it was some 400 miles distant 
from General Dobell's force. The column from Northern 
Nigeria was a mixed British and French Force watching the 
German posts of Mora and Garua in the extreme north of 
the Cameroons ; while the Cross River force from Southern 
Nigeria was in contact with German forces near Ossidinge. 

In January, 1915, it was decided to prosecute the campaign 
more actively in the Northern Cameroons with troops under 
the command of Brig. -General Cunliffe ; and during the year 
his column was actively engaged in reducing the fortified post 
of Garua and clearing the country southwards over the central 
plateau in order to converge on Jaunde with General Dobell's 
main force. 

General Aymerich also continued his operations from the 
east and south-east during 1915 and converged on Jaunde 
at the end of the year. 

In April, 1915, General Dobell issued orders for an advance 
on Jaunde which was to be made in conjunction with 
a similar movement of the French force from the East. 
A British force under Lieut. -Colonel Haywood was concen- 
trated at Ngwe, 30 miles from Edea, on the forest track 
between the railway at Edea and Jaunde, and a French force 
under Colonel Mayer concentrated at So-Dibanga also about 
30 miles from Edea where the railway crossed the Kele 
River. A force was also detached to the Sanaga River at 
Sakbajeme to protect the flank of the advance. 

This advance commenced on the 1st May, 1915, the French 
reaching Eseka railhead on the Midland Railway on the llth 



Mai. 
byt 

(1735) 





oh 
ilth 



OPERATIONS IN THE CAMEROONS 291 

May, and the British Wum Biagas, some 50 miles along the 
forest track from Edea to Jaunde, on the 4th May, where it 
was joined by the French force, which had turned north from 
Eseka to meet it. The combined force then advanced from 
Wum Biagas under Colonel Mayer on the 25th May. The 
difficulties of this advance were exceptionally great, and by 
the 5th June only 12 miles had been covered against stubborn 
resistance and with many casualties. Dysentery also broke 
out. Lack of transport prevented food supplies coming up 
with sufficient rapidity, and a serious attack on a convoy of 
500 carriers added to the difficulties. The advance was con- 
sequently abandoned and the force withdrawn, fighting 
rearguard actions, to Ngwe and the Kele River. Hostilities 
then ceased for the time being on the 28th June. The battle 
casualties in the operations were estimated at 25 per cent, of 
the force. 

The northern column under General Cunliffe had captured 
the post of Garua on the 10th of June, and a British and French 
force was then set free to move south through the highlands 
of the Cameroons, leaving a containing force at Mora, a post 
which held out to the end of the campaign. The French and 
Belgian columns under General Aymerich were also converging 
on Jaunde from the south and east, and the British force from 
Southern Nigeria at Ossidinge was attempting to link up with 
General Cunliffe's force and with the British force operating 
from the northern railhead at Nkongsamba and at Bare. 
Detachments were also sent to operate near the Nyong and 
Campo rivers on the coast south-west of Jaunde. 

During the temporary cessation of hostilities the 5th Indian 
Light Infantry arrived from the Straits Settlements and 
arrangements were made with the Governors of Sierra Leone, 
the Gold Coast and Nigeria for monthly reinforcing drafts 
of carriers. The roads were made fit for heavy traffic and 
adequate motor transport had been sent from England. 

These preparations enabled General Dobell to commence his 
second advance on Jaunde on the 22nd September, 1915. The 
British and French columns went forward as in the first advance 
from Ngwe and the Kele river. The former reached Wum 
Biagas on the 9th October, and the latter Eseka on the 30th 
October. The bush track from Edea to Wum Biagas was 
converted into a good motor road. On the 23rd November 
the final advance was commenced, the British force being based 
on Wum Biagas and the French on Eseka. The former fought 
its way to the more open and cultivated country at Dschang 
Mangas by the 17th December and the latter to Mangeles 
by the 21st December. The British force pushed on to Jaunde 

(1735) U 2 



292 MEDICAL HISTORY OF THE WAR 

and entered the town, as already noted, on the 1st January, 
1916. The French force reached the Kribi-Jaunde road from 
Mangeles shortly afterwards, and the French and Belgian troops 
from the east and south also entered Jaunde during the first 
week in January. 

The Northern and Southern Nigerian columns and the column 
of the Western force operating from the Northern railhead met 
at Fumban at the beginning of December, 1915. General 
Cunliffe's column had been engaged in November in a difficult 
attack on a mountain fortress at Banjo, and after its captur.e 
had sent detachments to join the other columns at Fumban. 
General Cunliffe then pushed on to the Sanaga river and estab- 
lished touch with the main force moving on Jaunde, leaving 
small forces to clear up the country beyond Jabassi. The losses 
during these operations were slight and the health of all ranks 
was considerably better than that of the troops operating in 
the coastal belt. 

In these varied and numerous operations the system of 
evacuation and methods of transport of sick and wounded 
differed considerably. From the British columns operating in 
the Northern Cameroons casualties were evacuated to Maidu- 
guri in the extreme north of Nigeria during the earlier operations 
against Mora in August, 1914, a five days' journey. Maiduguri 
continued to be the base to which sick and wounded were 
evacuated from the force left to contain Mora when General 
Cunliffe's main column marched south. 

In the unsuccessful attack on Garua in August, 1914, Yola 
was the base. The two medical officers with it, Drs. Lindsay 
and Trumper, West African Medical Staff, who had been left 
to pick up wounded when the column retreated, were captured 
and remained prisoners till released eighteen months later after 
the capture of Jaunde. They had been interned in a camp 
south of Jaunde on the Nyong river. Yola continued to be 
the British base to which wounded were evacuated during the 
later allied operations against Garua. After its capture the 
column advanced south by way of Kontscha, and the line of 
evacuation was then continued to Yola, with an intermediate 
aid post under a medical officer at Kontscha. 

When General Cunliffe's column was joined by a column 
based on Ibi for operations against the Banjo mountain fort 
on the 4th to 6th, November, 1915, the line of evacuation 
through Kontscha to Yola was abandoned and the sick and 
wounded were then evacuated through a bush hospital at 
Banjo to a medical base at Ibi. After the capture of Banjo, 
General Cunliffe's column moved south to N'gombe, sending 
a small column to Fumban to gain touch with the Cross river 




SECTION OF FIELD AMBULANCE ON LIGHT SCALE, 

Consisting of 4 equipments, with 32 carriers -(these wore no uniform), 
carriers in the photo, are stretcher bearers acting for them. 



The 



To face page 292. 



OPERATIONS IN THE CAMEROONS 293 

Column and the column from Bare. The line of evacuation 
both from Fumban and N'gombe continued to be to Ibi. 

The French forces with General Cunliffe's column were based 
originally on Fort Lamy at the junction of the Lagone and 
Chari rivers, not far from Lake Tchad, and their sick and 
wounded were evacuated to it during August and September, 
1914. In the operations against Mora and Garua they continued 
to be evacuated to Fort Lamy, an eight days' journey, but after 
the fall of Garua the French made a medical base there. The 
Garua, Yola and Ibi medical bases were on the navigable Benue 
river, and the French sick and wounded were evacuated by 
river craft from Garua to the sea and thence to French colonial 
bases. British sick and wounded were also sent by river from 
Yola and Ibi to Lokoja on the Niger when necessary. 

After General Cunliffe's allied column had reached the Sanaga 
river the sick were taken on with the column to Jaunde and 
evacuated thence to Duala by the line of evacuation of General 
Dobell's main force. 

The Cross River Column was based on Ikom, with a subsi- 
diary base at Calabar on the Nigerian coast. When it was 
attacked at Nsanakang on the 26th August, 1914, only one Euro- 
pean and 14 native ranks, amongst the wounded, were left alive. 
As there was also a large number of German wounded at the 
time in the area round Nsanakang the British consented to 
respect the area as neutral in -order that the Germans, who 
had forcibly retained the only medical officer with the British 
force to assist in the care of the wounded, might collect them. 
In the later operations the sick and wounded were sent down 
the Cross river from Ikom to Calabar ; but when the column 
joined forces with the Northern Railway column from Bare in 
the operations against Fumban its sick and wounded were 
evacuated by Bamenda and Dschang to the railhead at Nkong- 
samba and thence to Duala. From Duala they were evacuated 
by sea to the hospitals at Calabar. 

The French and Belgian columns operating against the 
eastern and southern areas of the Cameroons depended on 
river lines of evacuation to a very great extent. The southern 
force had its medical base at Libreville, a distance of 400 or 
500 miles from Ambam, which was the point reached before 
its final advance on Jaunde. It had about 400 battle casualties. 
Aid posts were formed on lines of communication at Oyem and 
N'Djole to which the sick and wounded were carried by bearers. 
At N'Djole they were taken by river launches down the Ogou 
to Cap Lopez where there was a small hospital, and thence by 
sea-going ships to the general hospital at Libreville. 

The eastern columns under General Aymerich advanced in 



294 MEDICAL HISTORY OF THE WAR 

two portions, the most southern from Bonga on the Congo at 
its junction with the Sanga river, and the other from Singa on 
the Ubangu river, which joined the Congo some 100 miles north- 
east of Bonga, and from posts farther north. Both the Sanga 
and Ubangu were navigable, the Sanga to Nola and some 
150 miles farther north to Carnot. The Dscha river which 
flowed into the Sanga at Wesso, on the frontier between French 
Equatorial Africa and the Cameroons, about 140 miles south of 
Nola, was also navigable as far as Molundu and Dongo some 
100 miles in a north-west direction. A small hospital base with 
stores was established at Wesso. In the advance to the west- 
ward of the Sanga from Carnot and Nola the columns had to 
rely on land transport, and also in the advance from Singa on 
the Ubangu to Carnot on the Sanga. From Carnot to Dume, 
from which the final advance on Jaunde was made, hand 
carriage over a distance of some 250 miles had to be used. 
On the navigable rivers sick and wounded were brought down 
in comfort by steam launches to base hospitals at Brassaville 
on the Congo. 

The various expeditions by the columns of the force based on 
Duala had also their own special means of evacuation. 

The Jabassi expedition in October, 1914, was up the Wuri 
river by a flotilla of river craft. One of the river boats acted 
as a dressing station and, when the force was withdrawn, 
brought the wounded down to Duala. In this small expedition 
3 Europeans and 13 natives were killed, and one European 
and 25 natives wounded. 

In the operations from the 1st October to the 6th October, 
1914, to secure Japoma, where the Midland Railway from Duala 
crosses the Dibamba Creek, 4 British and 29 French were 
killed or wounded. They were evacuated to the French ambu- 
lance at Aqua Town by hammocks and hand-pushed trucks 
along the railway line, and thence to the general hospital. 

In the operations along the Northern Railway sick and 
wounded, during the fighting in October and November, 1914, 
were also sent down the line in hand-pushed trucks or in 
hammocks as far as Bonaberi, and thence by launches across the 
Creek to Duala. In the subsequent advance to railhead in 
December, 1914, the only casualties were 12 killed and wounded 
in an action at Nlohe bridge. An advanced dressing station 
was formed there and the wounded evacuated down the line to 
Bonaberi by a train sent up with medical personnel for the 
purpose. On the capture of railhead at Nkongsamba, a small 
German hospital was taken over and became a clearing hospital 
for the advance to Dschang at the end of the month. 
Fifteen miles north of railhead the advancing column divided 



OPERATIONS IN THE CAMEROONS 295 

and a small post was formed at Melong, on the line of 
evacuation to railhead. The column withdrew to railhead after 
destroying Dschang on the 7th January, 1915. During the 
operations against Dschang and after the return of the forces 
to Nkongsamba, 133 soldiers and 323 carriers were evacuated 
down the line to Duala. The evacuation to railhead was by 
hand carriage over a distance of 50 miles. The battle casualties 
were 6 killed and 17 wounded. 

In February, 1915, there was much fighting in the neighbour- 
hood of Bare and Melong, north of the railhead. Ninty-nine 
wounded were collected in attacks on enemy positions, 
4 or 5 miles north of Bare, to a main dressing station there, 
and thence evacuated to railhead and Duala. In the final 
advance on Dschang and Fumban from the northern railhead, 
in October, 1915, aid posts were formed at Mbo, Dschang, 
Bogam, and Fumban, and sick and wounded evacuated through 
them to the clearing hospital at Nkongsamba. 

In the operations against Edea on the Midland Railway in 
October, 1914, by the land column and the river columns on 
the Sanaga and Nyong the casualties were 45 killed and 
wounded. A clearing hospital was formed at Dehane on 
the Nyong river, through which 30 sick and wounded were 
evacuated by river craft to Duala. The sick and wounded 
of the railway column, 30 in all, were taken down the line 
by hand carriage to Japoma, and thence by train to Duala. 
A German hospital was found at Edea, and a French ambu- 
lance was established in it for the remainder of the campaign. 

During the advance from Edea towards Jaunde in April, 
1915, a British clearing hospital was established at Edea, 
and two ambulance coaches were run by rail from there to 
Duala. The French field ambulance acted as a stationary 
hospital, and continued to treat the French sick and wounded 
until they were fit for evacuation to Duala. In the first phase 
of the operations against Ngwe the carriage by hand to Edea 
was over a distance of 30 miles. The further advance from Ngwe 
to Wum Biagas in May extended the line of hand carriage to 
60 miles. Although there were few wounded, large numbers 
of dysentery cases occurred during this period. They filled 
the bush hospitals, which consequently had to be constantly 
cleared to Edea to avoid further congestion. 

In this phase of the operations the British and French troops 
had been operating on separate though parallel lines ; but 
when, at the end of the phase, the French and British columns 
concentrated at Wum Biagas for a further advance they formed 
an allied force of 3,500 soldiers and carriers. A comprehensive 
scheme for evacuation of sick and wounded and for establishing 



296 MEDICAL HISTORY OF THE WAR 

medical posts had to be considered. Lieut. -Colonel Statham 
consequently joined the allied force, which had been placed 
under the command of Colonel Mayer of the French contingent, 
in order to direct the medical arrangements from Wum Biagas. 

An allied field ambulance, with a British and French section, 
was formed in addition to the section with the British troops 
and the regimental medical service of the French. The material 
with the section of field ambulance which had hitherto accom- 
panied the British column was reduced till it consisted of four 
medical equipments (20 loads), the loads of spare blankets, 
hammocks and hospital equipment being transferred to the 
British section of the allied field ambulance. This change 
rendered the ambulance section of the British troops more 
mobile and approximated it more to the regimental medical 
establishment with the French troops. 

The medical services then with the force, which consisted of 
627 British troops and 1,007 carriers and 837 French troops 
and 884 carriers, were as follows : 



Regimental Medical Service. 

Personnel : 

British. French. 

1 Senior medical officer. 2 Medical officers. 

3 Medical officers. 2 European infirmiers. 

1 R.A.M.C. N.C.O. 8 Native infirmiers. 

2 Dressers. No regular stretcher bearers. 
48 Stretcher bearers. 30 Carriers as a minimum for 
20 Carriers as a minimum for equipment and available spare 

equipment and augmented as required, 

from supply carriers when 
necessary for wounded and 
sick. 

Materiel : 
4 Medical equipments 6 Medical panniers. 

(12 Panniers). 30 Stretchers. 

20 Stretchers or hammocks. 



Allied Field Ambulance. 

British Section. French Section. 

Personnel : Personnel : 

2 Medical officers. 1 Medical officer. 

1 R.A.M.C. N.C.O. 3 European infirmiers. 

2 Dressers. 2 Native infirmiers. 
40 Carriers for equipment. 70 Carriers. 

Materiel : Materiel : 

24 Medical panniers. 10 Panniers. 

30 Hammocks or stretchers. 40 Stretchers. 




THE 4-STRETCHER BEARER SQUADS, 

Which were attached to each battalion and formed the bearer division 
of the section of field ambulance. 



To face page 296. 



OPERATIONS IN THE CAMEROONS 297 

Aid Posts (British). 

Two were established at Ngwe and Wum Biagas and two more arranged 
for, each with : 

Personnel : Materiel : 

1 Medical officer. 40 Medical panniers and loads. 

1 N.C.O. 30 Stretchers. 

1 Dresser or trained orderly 70 Light hammocks, 
and a sanitary gang. 

Clearing Hospital at Edea (British). 

Personnel : Materiel : 

1 Medical officer. 90 Medical panniers and loads. 

1 N.C.O. 30 Stretchers. 

1 Dresser. 70 Hammocks. 
8 Stretcher bearers. 

The allied field ambulance marched with the main body 
of the column, and the British and French regimental medical 
sections with the advanced guard, according to whether the 
advanced guard was found by British or by French troops. 
They evacuated their sick to their own section of the allied 
ambulance. 

Owing to the enemy's stubborn resistance the advanced guard 
was rarely half a mile in front of the main body instead of 
half a day as originally intended, so that the evacuation from 
the regimental units to the allied field ambulance could be 
carried out continuously. 

These extensive medical preparations had been necessitated 
by the size of the force, the probability of much sickness and 
heavy fighting, and the distance, 140 miles, along which sick 
and wounded men would have to be evacuated after Jaunde" 
was reached. 

There was also the probability that not only the sick and 
wounded of Colonel Mayer's allied column, but also those of 
the French columns marching on Jaunde from the south and 
east, would have to be evacuated through Edea, while the 
enemy wounded might also require treatment and evacuation. 
The allied column, however, after fighting for three weeks, 
never got farther than 12 miles from Wum Biagas, and in 
that short distance had lost one-third of its fighting effective 
by wounds and disease. 

During these operations 500 sick and wounded were evacuated 
in ten convoys to Edea and Duala. The system of evacuation 
was to utilize the returning supply carriers for carrying the 
wounded and sick. Three motor lorries working between 
Ngwe and Edea also helped in the evacuation between these 
two places. The sick convoys rested at aid posts, and a medical 
officer or non-cornmissioned officer took charge of them from 
one post to the other. 



298 MEDICAL HISTORY OF THE WAR 

In the final advance on Jaunde, which commenced in 
October, 1915, from Ngwe and So-Dibanga, the positions at 
Wum Biagas and Eseka, the former of which was occupied 
on the 9th November after a thirty hours' fight and the loss of 
28 killed and wounded, and the latter on the. 30th November 
with a loss of 28 killed and 85 wounded, were consolidated 
and prepared as advanced bases. The road to Wum Biagas 
was made suitable for motor traffic and the railway repaired 
to its railhead at Eseka. The advance was resumed on the 
24th November, the main British column throwing out 
flanking columns to the left and right, the former operating 
to the north as far as the Sanaga river, and the latter keeping 
touch with the main French column. Strong opposition was 
met with at various points. At the Puge river, 15 miles east 
of Wum Biagas, 25 of the British column were killed or 
wounded, and at Lesogs on the Kele River there were 
75 killed or wounded in the southern flanking column. 
Between the 8th and 17th December, when the columns emerged 
from the thick bush country to open cultivated land at Dschang 
Mangas, 7 Europeans and 78 natives had been killed or 
wounded. During the remainder of the advance to Jaunde 
there were 57 casualties in rearguard actions. The total 
British losses in the advance from Wum Biagas to Jaunde 
between the 24th November and 1st January were 238. 

The French column advancing from Eseka lost 203 killed 
and wounded and had only advanced 23 miles between the 24th 
November and 21st December, when Mangales was reached 
and where it halted till the 29th December. In its subsequent 
advance 32 more casualties occurred, but after the 4th January 
the enemy opposition against this column ceased. 

The sick and wounded of the British columns were evacuated 
through the clearing hospital at Edea. This hospital was 
equipped for 8 European and 150 native beds, with one medical 
officer, one R.A.M.C. N.C.O., and a dresser. A depot of medical 
stores was formed at Ngwe, and medical posts were established 
at Sakbayeme on the Sanaga river for the northern flanking 
column, and at Bombe .on the Edea-Ngwe road for the main 
column. After the capture of Wum Biagas the advanced 
medical depot was moved to it from Ngwe, and subsequently, 
as the advance progressed, to Ngung and then to Dschang 
Mangas. Small defensive posts were formed along the lines 
of communication and medical personnel was sent from Duala 
to each. The southern flanking column evacuated its wounded 
from Lesogs by bush paths to the French railhead] at Eseka. 
The northern flanking column carried its sick and wounded with 
it until it joined the main column. By the time the British 







MOTOR ROAD ON WAY TO JAUNDE. 




AMBULANCE COACH ON RAILWAY. 



To face page 299 



OPERATIONS IN THE CAMEROONS 299 

force had reached Jaunde there were seven aid posts between 
that place arid Edea, each with a bush hospital, a medical 
officer, and a N.C.O. of the R.A.M.C. or dressers. At some posts 
there were two medical officers, one of whom accompanied 
convoys of sick and wounded. At Dschang Mangas and Wum 
Biagas the posts and hospitals were larger and had on an 
average 100 in-patients as well as a large number of out-patient 
soldiers and carriers. 

During the period November 12th to February 29th, 117 
Europeans, 855 native soldiers and 3,426 carriers of the British 
force were evacuated to Duala through the bush hospitals 
on this line of communication and through the clearing hospital 
at Edea. 

The transport was by hand on stretchers or in the hammocks 
of returning supply carriers as far as Ngwe until such time as 
the roads were made fit for motor transport. Afterwards it 
was by motor transport with the exception of a section of 
22 miles of hilly road unfit for motors between Dshang Mangas 
and Wum Biagas. The motor transport consisted of four 
Ford ambulance cars augmented by all available supply lorries. 
As regards comfort there was not much difference between the 
Ford cars and the supply lorries. 

The journey by rail from Edea to Duala in ambulance 
coaches took four hours ; and the total journey from Jaunde 
to Duala six days or longer. 

The evacuation of sick and wounded of the French column 
was much simpler, as three-fourths of its advance was along the 
line of the Midland Railway. The column had eleven medical 
officers and a considerable number of subordinate medical 
personnel. Six of the medical officers were with the troops, 
one was with a field ambulance section, which followed the 
main column, and the rest were distributed to medical posts 
at So-Dibanga, Eseka and Mangales. 

During the coast operations from Kribi and Campo, medical 
bases were formed at these places and the sick and wounded 
evacuated by sea to Duala. 

During the operations which were conducted southwards 
after the capture of Jaunde and which drove the German 
forces into Spanish territory there were few battle casualties 
but a considerable number of sick. The line of evacuation 
was a long one ; the sick and wounded were carried by hand 
to the Kribi-Jaunde road at Olama, where a clearing hospital 
was formed. At first they were evacuated from there by 
motor transport to Jaunde, and thence by the Jaunde-Edea 
line of communication to Duala ; but later on all sick from 
Olama were taken by motor transport to Kribi and thence 



300 MEDICAL HISTORY OF THE WAR 

by sea to Duala. The French column operating south of 
Jaunde evacuated their sick direct to Jaunde. 

The means as well as the system of transport differed in 
the various expeditions. In the open country of the Northern 
Cameroons horses and even cattle were ridden by sick and 
lightly wounded, but generally and with all serious cases hand 
carriage in stretchers or hammocks, often for very long distances, 
was necessary. The second stage of transport from the 
Northern Cameroons was usually by large canoes or barges 
down the Benue, Niger, and Cross rivers from the medical 
bases at Yola, Ibi and Ikom to Nigerian depots or ports. 
At one period the Niger was closed for sick transport owing to 
the presence of sleeping sickness and the tsetse-fly along 
certain of its reaches ; but the use of mosquito- protected 
boats overcame this difficulty. 

In the south and east, where the French columns of General 
Aymerich operated, the use of hand carriage was necessary 
until either a temporary base or river transport was reached. 
The French forces made extensive use of the system of establish- 
ing small and isolated hospital posts on the lines of communi- 
cation where serious cases could be left. The very limited 
numbers of their medical staff prevented a regular line 
of communication for sick being kept open. When the 
Lobaje, Sanga and Dscha rivers had been reached, boat 
transport became generally possible. Once a patient 
reached a navigable river like the Sanga he could be taken 
hundreds of miles down it and so on to the Congo and to 
Brazzaville if belonging to the eastern columns, or down the 
Ogowe and Gabun rivers towards Libreville if invalided from 
the French southern forces. Railways could not be employed 
with the French southern and eastern columns, and only very 
partially for the northern columns, and then not till they had 
already reached a large town or depot. 

With the coastal or western columns hand carriage was used 
along bush paths and on roads where no wheeled transport 
was employed, but on the more important of the various 
expeditions, those against Jaunde for instance, motor transport 
was used as far as possible for all but very seriously sick 
or wounded patients, in which case the gentler method of 
hand transport was employed. Railway transport was utilized 
when the line of railway was reached. 

Various types of stretchers and hammocks were employed 
for hand carriage. The simplest type of stretcher in forest 
country was the bush stretcher which had a framework of 
light forest poles and a bed of thin strips of bark neatly entwined. 
Such a stretcher as this would be rigged up in half an hour 



OPERATIONS IN THE CAMEROONS 301 

by the native carriers and was fairly comfortable and springy, 
and lasted about a week. In all the various columns operating 
in the forest region of the Cameroons this stretcher was used 
to the utmost possible extent. The use of bush stretchers 
saved transport, for there was no reason to return them from 
the base. The method was also hygienic, as stretchers soiled 
by septic wounds or dysenteric evacuations could be thrown 
away when necessary. A better class of bush stretcher was 
occasionally used. It was made from poles of the tumbo palm, 
an exceptionally light wood, with a matting of its fibre or of 
similar fibre as bed. This bush stretcher was very light and 
nearly as comfortable as a canvas stretcher, but it took 
about a day or two to make. These stretchers, however, lasted 
very well. 

With most of the columns, for immediate use and for the 
transport of Europeans and bad cases, a certain number of 
canvas stretchers was carried. The stretchers of the companies 
were of this pattern and a reserve, varying with the various 
forces, went with the companies or with sections of field 
ambulances. They were of two types, the regulation folding 
stretcher and a rigid stretcher locally constructed of pitch pine 
and canvas. By making the stretcher poles rectangular, 
and fixing them so as to support the weight on their greater 
diameter, the thickness could be cut down till the stretcher 
did not weigh more than 22 Ib. as against 30 Ib. of the army 
pattern. 

As the native carriers carried stretchers as well as hammocks 
on their heads, light head-boards were fixed to the ends of the 
rigid stretchers, and for this reason these light rigid stretchers 
were generally preferred to the army folding pattern to which 
transverse head-boards could not be attached. 

The ordinary type of hammock used on the West Coast 
consists of a heavily constructed wooden framework covered 
with canvas. This forms what is called a hammock top. 
Suspended below this is the body of the hammock which 
generally consists of intertwined string or of some kind of 
canvas. These tops were so heavy that, although they had 
certain advantages in comfort and were used in some of the 
other forces, they were discarded with the western force, 
and a hammock with a very light top, made from four light 
tumbo poles and a seven foot by three and a half oblong of 
canvas, used instead. The top weighed about 5 Ib. as against 
the 40 to 50 Ib. weight of the old pattern. 

Instead of a hammock body of string or canvas, a naval cot 
could be slung under a hammock top. The ordinary naval 
cot is fairly heavy and in order to save weight a cot was designed 



302 MEDICAL HISTORY OF THE WAR 

with a framework of tumbo poles and with sides lower than 
those of the naval cot. This modified naval cot, when carried 
slung on the light top already described, proved an exceedingly 
suitable combination, which Lieut. -Colonel Statham strongly 
recommended as the most suitable for use in the future. 

The general conclusions come to by medical officers with 
the northern and western columns was that string hammocks 
rotted so easily as to be unreliable, that wire should be used 
instead of nails to join the hammock poles, as the latter split 
and destroyed the poles, that plenty of spare rope should be 
carried in the equipment, and that every eyelet in cot or 
hammock should be ringed with metal. 

Canvas stretchers and hammocks, though marked for urgent 
return to the front from the lines of communication, usually 
took days and weeks to come back. For this reason a spare 
stock was absolutely necessary, and the most economical 
method of distributing them was always a problem. The 
method adopted with the western columns was to keep spare 
stocks of hammocks and stretchers at each aid post or bush 
hospital on the lines of communication. An empty one then 
went up as the loaded stretcher or hammock came down the 
line. It was only by constructing specially light stretchers 
and hammocks that this spare stock could be maintained. 
The ordinary heavy type would have employed an unjustifiably 
large number of supply carriers for their transport. 

The system of carrying a stretcher or hammock on the head, 
though suitable in the case of the hammock where the body 
hangs lower, is unsuitable in a stretcher where the patient is kept 
six feet or so above the ground. It was only rarely, however, 
that carriers could be trained to carry patients with their hands 
or on their shoulders. Trained hammock bearers travel safely 
and rapidly, but, as they march in step, they jolt the patient 
a good deal. To teach the African the broken step was even 
harder than teaching him to carry a stretcher on slings. For 
this reason the corps of stretcher and hammock bearers formed 
with the western force was of the greatest value. Kept at 
one class of work they became skilful at carrying, and their 
uniform gave them self-respect and the courage required to 
collect wounded from the firing line. Bitter complaints were 
made by the medical officers of other columns because of the 
constant changing of the medical carriers and the consequent 
discomfort to patients from being carried by men who were 
not thoroughly trained or experienced. 

Motor transport was only used by the western column, 
the four Ford ambulance cars and every available supply 
lorry being utilized. The Ford ambulances could not carry 




MOTOR AMBULANCE CARS. 



To face page 303. 



OPERATIONS IN THE CAMEROONS 303 

satisfactorily the theoretical load of four in consequence of 
insufficient space, and with two they were somewhat jolty from 
being too lightly loaded. The supply lorries, though some- 
what too short for a lying down case, were comfortable 
and carried down large numbers of sick and wounded 
safely and expeditiously. Rail transport was also only used 
with the western columns, six coaches being fitted out, 
usually with sixteen bunks in each. They proved comfortable 
and very useful. 

Medical stores were brought from the West African colonies, 
chiefly from Nigeria, with the expeditionary force. Monthly 
and quarterly consignments were subsequently obtained from 
England. These included hospital clothing and bedding, field 
medical equipment, field medical stores and comforts, base 
hospital supplies, and medical stores for the plantations and 
for the civil population. They were housed in four buildings 
at the Duala general hospital and supplied not only the 
expeditionary force, but also the British Navy, the French 
troops, 14 small hospitals of the cocoa plantations, which had 
a population of 12,000, and the police, prison and civil population 
of the occupied territory. A carpenter's shop was established 
in connection with the medical stores, where some 800 hospital 
beds and 120 hammocks and stretchers were made at small 
cost. The stores issued to medical units in the field consisted 
of over 1,000 loads of medical and surgical material and 2,000 
loads of equipment. 

Measures for the prevention of disease included water 
sterilization, destruction of insects and vermin, and questions 
connected with rations and clothing. Fifty-two thousand 
and forty men were employed on sanitary services at a cost 
of Is. 6d. daily between October, 1914, and March, 1916, the 
numbers varying in each month from 7,382 in October, 1914, 
to between 2,000 and 3,000 monthly up to December, 1915, 
and January, 1916, when some 4,000 were employed in each 
of these two latter months. In the Duala areas alone some 
900 were employed chiefly in disposing of empty tins and 
bottles, in the removal of garbage and latrine contents, and in 
the destruction of mosquitoes and rats. 

Duala had a good water supply from deep wells, distributed 
to standpipes and houses, and general measures of sterilization 
were not required. In the field, boiling and chlorination were 
employed, but it was difficult to prevent the West African 
native, who often prefers water with a taste in it, from drinking 
from polluted sources. 

Anti-mosquito measures were mainly directed towards the 
prevention of yellow fever through stegomyia mosquitoes. 



304 MEDICAL HISTORY OF THE WAR 

Tins and receptacles which were apt to be breeding places 
were buried, and so many millions were thus disposed of that 
considerable areas of ground were reclaimed. There was always 
a danger of serious outbreaks of small-pox, and a monthly 
supply of vaccine enabled the medical staff to vaccinate many 
thousands of the natives. Plague was apt to be imported 
from French Guinea and Dakar. Suspected cases were 
examined bacteriologically and the destruction of rats was 
carried out on a large scale. 

The rations of the European troops had a high calorie value, 
but that of the native soldiers and carriers consisted only of 
| Ib. biscuit, f Ib. rice, and Ib. meat, or J Ib. biscuit, f Ib. meat, 
and J Ib. chocolate. The calorie value was consequently 
extremely low, but the native could supplement the ration by 
bananas, cassava and yams found on the line of march, thus 
effecting much economy in transport. 

The health of the troops, with the exception of those operating 
in the northern areas, was a constant cause of anxiety. The 
total strength of the forces based on Duala varied from time 
to time. At one time or another, exclusive of British and 
French naval personnel, there were 864 British and 805 French 
European troops, 5,927 British and 5,699 French native troops, 
14, 184 British and 5,035 French imported carriers, and 10,000 
to 15,000 carriers obtained locally for the British and an 
indefinite number for the French. 

To deal separately with the varying health conditions of 
each of the numerous columns has not been possible, and 
general statements must be accepted as only approximately 
accurate. The sick-rate of the column depended not only 
on the physical questions of climate, food, and water supply, 
but on various psychological factors, such as success, excitement 
and movement, which were found to diminish the sick-rate ; 
while reverses and prolonged halts greatly increased it. 

The reports of medical officers with the northern columns 
varied considerably. The sick-rate of the troops of the Ibi 
and Yola columns, when these halted, was stated by some to 
be 20 or 25 per cent., while the rates amongst the carriers were 
much lower. On the other hand, the health of the Yola column, 
when on the march, was stated by one medical, officer to be 
only 2 or 3 per cent. With the coastal forces and the 
Cross River column from Southern Nigeria, which operated 
in very unhealthy country during most of the campaign, 15 to 
20 per cent, of the troops were treated either as in- or out- 
patients when the troops were on the march, and 30 to 40 per 
cent., and occasionally more, when the troops were stationary. 
Although no definite information is available from the French 




WARD IN BASE HOSPITAL, DUALA. 



To face page 305. 



305 

eastern columns, it was ascertained from combatant and 
medical officers with these columns that the sick-rate during 
most of the advance had not been high. 

It is impossible also to standardize the results in the various 
forces operating in the Cameroons, owing to their medical 
arrangements being dissimilar. Few or no actual statistics 
are available from any other force than the western, and 
the only accurate information available regarding diseases 
is obtained from an analysis of 24,261 in-patients and of 
25,000 out-patients treated at Duala base hospitals.* The 
impossibility of keeping reliable statistics and collecting 
them from numerous small columns widely separated in 
a bush country rendered any complete collection of figures 
impossible. 

The most remarkable fact shown by these figures of in-patients 
and out-patients was the number of cases of tropical ulcer, 
which formed over 90 per cent, of the 7,200 cases of minor 
septic diseases, or over 25 per cent, of the entire number of 
cases admitted ; and 12,928 out of the 25,000 out-patients or 
50 per cent, of all the out-patients' cases. In the northern 
columns this disease was not nearly so prevalent while they 
operated in the healthy upland plateaux, but its incidence 
rapidly increased as the northern troops entered the low-lying 
bush country, till finally some 20 per cent, of the native troops 
and 30 per cent, of the carriers were affected. Tropical ulcer, 
besides spreading rapidly in the unhealthy coastal region and 
becoming almost epidemic in the nature of its increase, proved 
so difficult to cure as to render any soldier or carrier affected 
with it unfit for service for weeks. Unless the ulcer was a 
small one and treated early, invaliding was found to be the 
soundest policy to adopt in these cases. Of 12,071 allied 
cases invalided during the course of the campaign and 1,200 
invalided within a month or two after its cessation, 32 per 
cent, were returned as tropical ulcer. Of these cases 3,976 
were from amongst the 9,877 carriers invalided. There 
were no cases of this disease amongst the 519 European 
military invalids, and only 126, or 13 per cent., from amongst 
the 1,675 native soldiers who were invalided. 

These figures show the value of foot and leg protection in 
preventing this disease, a point which was still further brought 
out by its incidence amongst the French native troops who 
always wore trousers and amongst whom only 46 cases occurred, 
or 5 per cent, amongst 990 invalids. The British native 
troops wore foot protection, but leg protection in only some of 

* See Aopendix F. 
(1735) X 



306 MEDICAL HISTORY OF THE WAR 

the units. Foot and leg protection greatly reduced the sick- 
rate due to cuts, abrasions and chigger sores as well as tropical 
ulcer, and some form of soft ammunition boot combined with 
the wearing of cheap strong leggings would have been highly 
beneficial for all ranks. Boots were tried with a section of one 
Nigerian battalion, but were not a complete success owing to 
blisters developing on the men's feet. The period of trial, 
however, was too short to be decisive, and the native soldier 
has to be accustomed to his boots long before he enters the 
field. Sandals and chupplies, which were much worn, did not 
protect the feet as well as boots, nor did they keep out chiggers 
equally well. 

About 346 of the minor septic admissions were due to chiggers, 
some 5 per cent, of the total, but this percentage did not 
represent the prevalence of this pest in certain areas of the 
Cameroons, where its serious effects upon those native soldiers 
who had no experience of this minute burrowing insect or how 
to extract it without leaving a small sore where it burrowed, 
caused at one period serious military inconvenience. The 
Northern Nigerian troops employed with the western column, 
were crippled at one time by chiggers and were only rendered 
fit by the combined employment of sandals and frequent foot 
inspections. For treatment the feet were coated with mixtures 
of paraffin and tar, and the stretcher bearer corps, who 
were mainly Sierra Leone carriers, were detailed as company 
chiropodists. 

Of specific diseases malaria occupied the most important 
place in all the forces operating in the Cameroons. The Duala 
hospital admissions, however, do not give any idea of the 
prevalence of this disease amongst Europeans, as the greatest 
number of attacks took place while they were in the field, where 
the European was treated in his own bush tent or in the hospital 
tents of the field ambulances or local aid posts. There 
were some 3,000 Europeans employed on military duties with 
the various forces. Many of these men had over a dozen 
malarial attacks during the seventeen months of the campaign, 
while scarcely any escaped one attack. The 613 recorded in the 
Duala base hospital from among 1,514 European admissions 
do not present a true estimate of the local importance of the 
disease or its proportional incidence, which must have been 
considerably higher than 40 per cent. There were, however, 
few deaths from malaria or blackwater fever ; only 13 and 5 
respectively from among 2,410 cases of malaria and 11 cases of 
blackwater fever at Duala among all ranks of the western 
force. Prophylactic quinine was probably taken by all 
Europeans of the force. This was certainly the case with those 





OPERATING ROOM, BASE HOSPITAL, DUALA. 



To face pdge 306. 




LABORATORY, BASE HOSPITAL, DUALA. 



To face pjge 30 ;. 



OPERATIONS IN THE CAMEROONS 307 

of the western column, where only 147 Europeans were 
invalided for malaria or anaemia following malaria. 

Dysentery caused 1,850 admissions to the Duala hospital, 
of whom 100 were Europeans. There were 176 deaths from 
this disease, and 1,027 cases, of whom 47 were Europeans, 
were invalided. The disease was amoebic in type in 65 per 
cent, of the cases, the remaining cases being bacillary. 

Pneumonia was very prevalent- in the wet season especially 
among the carriers. On the advance to the higher plateau 
from the Cross river the great difference in temperature 
between night and day was regarded as the cause of much 
pneumonia amongst the carriers, who were not suitably clothed 
for this change of climate. From the figures obtainable from 
the western column there were 838 in-patients and 156 deaths 
from pneumonia, while 496 troops and carriers were invalided 
for this disease during the course of the campaign. Seventy- 
three were invalided on account of tubercle, though only 
61 admissions are recorded in the returns. Other respiratory 
diseases gave numerous admissions chiefly from bronchitis, 
broncho-pneumonia, and pleurisy. Of the 24,261 analysed 
admissions 1,949 and of the 25,000 out-patients 2,407 were 
cases of these diseases, while 803 cases were invalided. 

Rheumatism caused considerable wastage. More than 10 per 
cent, of the out-patients, 2,634 out of 25,000, and 1,138 of the 
in-patients being cases of rheumatism, while 375 were invalided. 

Beri-beri occurred almost exclusively among the French, 
329 of the 348 admissions to hospital for the disease and 311 
out of the 315 invalided being amongst French troops. It was 
attributed to the use of Cochin China rice. 

The 1,514 admissions of Europeans to hospital give no 
accurate idea of the European sick-rate as the vast majority 
of sick Europeans were treated in their quarters or in the bush 
hospitals, where reliable statistics were not obtainable. It 
may be said, however, that considering the prolonged and 
arduous nature of the campaign and the bad climate the 
Europeans of the western columns escaped lightly. Fifty 
per cent, of the admissions amongst them^were due to malaria 
and anaemia, and of other preventable diseases dysentery 
caused only 100 admissions, and there were only six cases of 
typhoid fever amongst the 1,669 Europeans of the western force. 

Amongst native troops and carriers, only 1,750 cases of 
dysentery and 1 ,797 cases of malaria are recorded in the analysis 
of in-patients, while there were no cases of typhoid, yellow 
fever, small-pox, or plague, diseases which were more or less 
prevalent at the time in the colonies bordering on or in 
communication with the Cameroons. 

(1735) X 2 



308 



MEDICAL HISTORY OF THE WAR 



The invaliding rate was high among native carriers, but 
the carrier ceased to have the value of his upkeep when he 
could not undertake full work. For this reason locally engaged 
carriers were discharged when not up to work, and imported 
carriers invalided unless they were likely to recover sufficiently 
to carry loads of 60 Ib. to 70 Ib. in weight on the head for 
several hours a day and not break down under the strain. 
The high invaliding rate of the western column, therefore, 
was an expression of the military importance of avoiding the 
necessity of maintaining rations for useless or semi-useless 
men, rather than an index of their ill-health. 

The number of killed, wounded and died of disease, noted 
as occurring amongst the forces with General Dobell, is as 
follows : 









Killed. 


Wounded. 


Died of 
Disease. 


Europeans (British) 






24 


30 


6 


Europeans (French) 






26 


50 


19 


Native soldiers (British) . . 






193 


557 


84 


Native soldiers (French) . . 






232 


571 


99 


Imported carriers (British) 






26 


31 


309 


Imported carriers (French) 






12 


33 


163 


Total 







513 


1,272 


680 



The casualties amongst General Aymerich's forces were 
stated to be 1,091, and in General Cunliffe's columns 700. 
These figures are, however, only approximately accurate. 

It will be seen that amongst the combatant ranks the number 
killed was 475, as compared with only 208 deaths from disease. 
Amongst the carriers, 38 were killed and 472 died of disease. 
The ratio between the battie casualties and deaths from 
disease must be regarded as remarkable, when the duration 
of the campaign and the nature of the climate are taken into 
consideration. 

The losses amongst the medical establishments were as 
follows : 





Killed. 


Wounded 


Died of 
Disease. 


Invalided 


British medical officers 


_ 


3 


_ 


13 


French medical officers 








1 


3 


R.A.M.C. N.C.O.'s 





2 





3 


French infirmiers 


2 


2 








British native dressers . 







2 


10 



The only detailed record of the nature of the wounds is that 
of 535 serious cases of gunshot wounds admitted to the main 



OPERATIONS IN THE CAMEROONS 309 

surgical ward of the Duala hospital between October, 1914, 
and February, 1916. The regional distribution of these wounds 
was as follows : 



Head and neck 
Upper limb 
Thorax 

Abdomen and pelvis 
Lower limb 



47 of which 5 were compound fractures. 
189 70 
40 4 
16 5 



Total .. 535 135 

There were 38 deaths, five being due to inter-current dysentery 
or pneumonia. Ten deaths followed serious compound fractures 
of the femur, four of these dying shortly after admission to 
hospital. One death occurred from fracture of the fifth cervical 
vertebra, and three from serious gunshot wounds of the 
abdomen. There were seven cases of tetanus, all of whom 
had received anti-tetanus serum before or after the onset of 
the symptoms. Four of them died. The results obtained in 
the surgical ward were good, considering the serious nature 
of the wounds, which were inflicted by bullets usually at very 
close range, and often of large calibre or of the dum-dum type. 
Colonel Statham remarks that " these good results were not 
due to any of the later methods employed in Europe, but were 
obtained with the more commonly known antiseptics, chiefly 
cyllin and carbolic acid. The use of the continuous antiseptic 
bath was a great feature of the treatment, and was attended 
with happiest results." According to the reports of the X-ray 
laboratory at the Duala hospital, bullets of various calibre 
and structure had been used, from the military nickel bullet 
to soft-nosed and large lead bullets of old pattern police and 
sporting rifles. 



CHAPTER XIX 

THE MEDICAL SERVICES IN SOUTH AFRICA 

BEFORE the outbreak of war there were two separate and 
distinct military medical services in South Africa: the 
medical services of the Imperial garrison represented by the 
R.A.M.C. under the War Office, and the South African Medical 
Corps which was in process of organization for the Union Defence 
Forces under the Minister of Defence. The officers and 
personnel of the latter, together with a South African military 
nursing service, were on a volunteer basis similar to that of 
the territorial force units in the United Kingdom ; and, with the 
exception of those for the permanent Union troops, such as 
the South African Mounted Rifles, had not yet been completely 
organized for training, and were intended to be embodied 
only in time of war. 

The Imperial medical services were under the administrative 
control of a D.D.M.S., Surgeon-General W. G. Bedford, the 
South African Medical Corps under a staff officer for medical 
services, Major P. G. Stock, who had formerly been an officer 
of the R.A.M.C. This dual factor dominated the medical 
arrangements in South Africa throughout the war period. 

At the commencement of the war all the Imperial troops, 
with the exception of two companies of the R.G.A., a field 
company of the R.E., departmental details, and some details 
left to train the South African volunteer units, were withdrawn 
for service in Europe. The authorized establishment of the 
R.A.M.C. at the time was 24 officers, including quartermasters, 
and 162 other ranks. Surgeon-General Bedford and all of them 
except Lieut. -Colonel Seaton and Lieut. -Colonel Buist and about 
six other ranks R.A.M.C. left for Europe in September, and the 
military hospitals,* except those on the Cape Peninsula, were 
closed. Lieut. -Colonel Seaton then became senior medical officer 
of the Cape Peninsula garrison for a short time. He was 
succeeded by Lieut .-Col. Buist, who was given additional 
duties in connection with the organization and training of the 
Union Defence Force at its Cape Town base, with the temporary 
rank of colonel. There were left with him a staff-sergeant, 

* There were five R.A.M.C. hospitals in South Africa at the time : Potchef- 
stroom, Maritzburg, Roberts Heights near Pretoria, Tempe near Bloemfontein, 
and Wynberg on the Cape Peninsula. 

310 



SOUTH AFRICA 311 

a sergeant-dispenser, an X-ray laboratory orderly, and one or 
two of the clerical section R.A.M.C. Colonel Buist left South 
Africa at the beginning of November, 1915, and was succeeded 
by Major, afterwards Lieut. -Colonel, Wright, who had retired 
from the R.A.M.C. and had settled in civil practice at Simon's 
Town. Lieut. -Colonel Wright continued to hold administrative 
charge of the medical services for such Imperial purposes as 
were not undertaken by the Union Defence Force during 
the remainder of the war period. 

Civil medical practitioners were engaged by Surgeon-General 
Bedford before he left, for the medical charge of details of Imperial 
troops and women and children .who were unfit to travel or 
were detained up country after the departure of the expedi- 
tionary force, arrangements being made for the admission of 
military patients to civil hospitals in Pretoria and Maritzburg 
at a fixed charge of 10s. daily for adults and 5s. for children. 
The military hospitals on the Cape Peninsula consisted of 
a dieted hospital at Wynberg with 75 beds, and non-dieted 
hospitals in the Castle, Cape Town, with 16 beds, and at 
Simon's Bay with 18 beds. 

The Imperial military command, so far as its medical services 
were concerned, was thus reduced to the status of a local 
garrison in the Cape Peninsula, with Lieut. -Colonel Seaton and 
afterwards Lieut. -Colonel Buist as senior medical officer, and 
with Major Wright as senior medical officer of the Simon's Bay 
defences. 

According to the Cape defence scheme, the hospital 
accommodation at Wynberg was to be increased by 270 beds, 
or half a general hospital ; the Castle hospital by 40, and Simon's 
Bay by 20 beds ; but when mobilization took place it was not 
considered necessary to carry this out and the actual increase at 
that time was 20 beds at Wynberg and the Castle, and 10 beds 
at Simon's Bay. The equipment of half a general hospital 
was, however, maintained in mobilization stores at Wynberg 
and both it and the hospital itself were transferred on loan 
to the Union defence authorities, with a quartermaster- 
sergeant, wardmaster and steward clerk of the R.A.M.C. as the 
only R.A.M.C. personnel, the place of the R.A.M.C. personnel 
which had been withdrawn being taken by members of No. 1 
Company of the South African Medical Corps, who were called 
up for service under the Defence Act. Its rank and file had 
been trained in elementary stretcher drill only, but had no 
experience of hospital or nursing duties. A training depot was 
formed under Lieut. -Colonel Usmar, who had as his adjutant 
Lieutenant and Quartermaster Richardson, an ex-Q.M.S. of 
the R.A.M.C. Qualified nurses of the South African Military 



312 MEDICAL HISTORY OF THE WAR 

Nursing Service supplemented the personnel of the No. 1 
Company S.A.M.C., and the medical officers were highly qualified 
civil practitioners. The arrangements with the Union defence 
authorities were to the effect that the sick of Imperial troops 
would be treated in the military hospital at a fixed daily charge, 
that all medical personnel of the South African Medical Corps 
and South African Military Nursing Service in the Cape 
Peninsula were to be under the orders of the General Officer 
Commanding in South Africa and that communications on 
military medical matters were to be submitted to him through 
the senior medical officer of the Imperial service, who received 
the instructions of the Minister of Defence through his 
director of medical services. 

When war was declared, the mobilization of an expeditionary 
force for operations against German South-West Africa was 
commenced. Cape Town was to be its main base, and mobi- 
lization camps were prepared at various places on the Cape 
Peninsula. The forces mobilized, however, were entirely 
Union forces and did not come under the command of the 
Imperial military authorities. But considerable work was 
thrown on the Imperial senior medical officer in connection 
with them. Large increases in hospital accommodation became 
necessary. The military hospital at Wynberg was expanded 
into a general hospital, a second general hospital was established 
at Maitland, a suburb of Cape Town, and a hospital transport, 
the " City of Athens," and a hospital ship, the " Ebani," 
organized. The latter was equipped under the directions 
of defence headquarters and the official advisory committee 
on voluntary aid, with additional comforts from the South 
African Red Cross Society. The personnel was obtained from 
the South African Medical Corps. On the termination of the 
German South-West African campaign the " Ebani " was 
transferred to the Imperial authorities, and was used as a 
hospital ship in various places. Those of its staff of South 
African Medical Corps who remained on board were 
transferred to the R.A.M.C. 

Owing to the rebellion in South Africa at the end of 1914 
the departure of a portion of the expeditionary force for 
operations against German South-West Africa was postponed. 
After its return in July and August, 1915, on the termination 
of the campaign, general demobilization took place. The 
general hospital at Wynberg was then rapidly reduced and 
reverted to its original status as a military hospital under 
the General Officer Commanding, and the medical services, 
under Lieut. -Colonel Buist, were concerned with ordinary 
routine medical and sanitary work in connection with the 



SOUTH AFRICA 313 

Peninsula defence troops and with the medical examination of 
recruits for the South African contingent, which had been 
formed for service in Europe. Colonel Stock accompanied the 
contingent to Europe, nominally in command of a general 
hospital, but also as senior medical officer and subsequently 
as D.D.M.S. of the contingent. 

The medical services at the Cape were not called upon for 
further expansion of their work during the war, until the 
War Office decided to organize a large expeditionary force 
from volunteers in South Africa for service in German East 
Africa. General Smith-Dorrien with his headquarters staff 
arrived in Cape Town early in January, 1916, to command the 
force. His D.M.S. was Surgeon-General D. G. Hunter, and 
it was decided by him in consultation with the G.O.C. of the 
Command to make the Cape Peninsula the hospital base, to 
which sick and wounded from East Africa should be evacuated. 
Durban had been under consideration for this purpose, but 
was then rejected because it was feared that its climate would 
be prejudicial to patients and convalescents returning from 
field operations in a tropical and unhealthy climate, although 
it was three .days by sea nearer the base of operations. Subse- 
quently, however, Durban became a large hospital centre. 
Two general hospitals were again organized, No. 1 in Wynberg 
Camp, which provided accommodation for 850 beds in huts 
and 400 under canvas, and No. 2 was again opened at Maitland, 
with accommodation for 1,100 and ample room for expansion 
by tentage. Owing to the mobilization of a general hospital 
for service in Europe and the demand for as many medical 
officers as possible from South Africa for service with the 
R.A.M.G., most of the experienced medical officers, nurses and 
subordinate medical personnel had left the Cape, and arrange- 
ments were consequently made with Colonel Knapp, who was 
acting as D.M.S. of the Union at Pretoria, to open recruiting 
amongst volunteers of the South African Medical Corps in 
order to provide the personnel for these two hospitals. He 
appointed Colonel Temple-Mursell, of the S.A.M.C., who was 
a Johannesburg consulting surgeon, to command No. 1, and 
Lieut. -Colonel McGregor to command No. 2 General Hospital. 

As all the hospitals were staffed by officers and men enlisted 
in the South African Medical Corps they came under the 
control of the D.M.S. of the Union at Pretoria, who appointed 
the S.M.O. of the Imperial command to be his A. D.M.S. in 
the Cape Peninsula, so that the latter continued to administer 
the medical services there in a dual capacity. 

The establishment of a general hospital, laid down in War 
Establishments, was followed as far as possible, but, owing 



314 MEDICAL HISTORY OF THE WAR 

to the scarcity of experienced male nurses the number of 
nursing sisters was largely increased, and coloured labour was 
employed for menial general duties which the South African 
Medical Corps orderlies were not called upon to perform. 
There was an ample supply of qualified lady nurses in South 
Africa, and the acting Matron-in-Chief, Miss Nutt, who had 
retired from the Q.A.I.M.N.S. and had succeeded Mrs. Creagh 
of the S.A.M.N.S. when the latter left with the contingent 
for Europe, was able to select a number of extremely com- 
petent nurses. Cooks were drawn from the rank and file and 
placed under the control of a civilian chef. Indians were 
ultimately employed in their place.* The officer establish- 
ment consisted of the commanding officer, the adjutant, the 
quartermaster, and on an average 22 medical officers for 
general duty. Surgical and other specialists were also 
appointed to each hospital. Equipment was obtained partly 
from local resources and partly from the military medical 
and ordnance stores at the Cape, but, in anticipation of 
requirements, the War Office had been asked to send out the 
complete equipment of a general hospital.f 

No. 1 General Hospital was ready in February, 1916, and 
a nucleus staff was then transferred from it to organize No. 2 
General Hospital at Maitlarid. Evacuation of sick and wounded 
from German East Africa, however, did not commence to any 
great extent until January, 1917, and, consequently, there 
were not enough sick in the Cape Peninsula to fill No. 1 during 
1916. 

Apparently the necessity of maintaining, in these circum- 
stances, the personnel for No. 2 General Hospital pending the 
arrival of convoys from East Africa was not realized, for after 
the question had been referred to the authorities in East 
Africa orders were issued on the 15th September, 1916, to 
close the hospital and disperse the personnel. A nucleus of 
the most experienced men was fortunately retained, and two 
months later orders to re-open the hospital for large convoys 
suddenly reported to be on their way from East Africa were 
received. Orderlies had again to be recruited, but in fewer 
numbers, as many of them had been replaced by lady pro- 
bationers, a large number of whom had volunteered for duty 
arid proved veiy satisfactory. 

The medical examination of recruits of all classes, white 

* In October, 1916, lady cooks were appointed to release men of the 
S.A.M.C. for service overseas, but were only employed for a short time at 
Wynberg, although employed in other hospitals in South Africa. 

t It arrived just in time to provide beds for a heavy convoy of sick and 
wounded which arrived in January, 1917. 



SOUTH AFRICA 315 

and coloured, and for European as well as for East African 
theatres of war, was carried out continually from the forma- 
tion of the East African Expeditionary Force until the 
Armistice. A recruiting medical board under the direction 
of Lieut. -Colonel J. Hewat, S.A.M.C., was established at 
Cape Town where all recruits from up country districts 
were re-examined. A special feature was recruiting for the 
Royal Air Force in 1917 and 1918 amongst the youth of South 
Africa. Examinations for this force were conducted at Cape 
Town and Johannesburg by officers specially appointed by 
the D.M.S. for the purpose. Other centres were also visited 
by a special medical officer on recruiting tours in 1917 and 
1918. Four hundred were passed fit in 1917 and sent to 
England, and 1,274 in the second recruiting tour, of whom 
1,024 went to England and 250 to Egypt. Two hundred and 
twenty-six more were waiting embarkation when the Armistice 
was signed. 

Coloured and native recruits were enlisted into the South 
African Labour Corps in large numbers. They were obtained 
through the magistrates in native districts and mobilized in 
the Cape Peninsula, where a large camp was formed for them. 
There the men were equipped, medically examined, and 
inoculated against enteric and a large number also against 
pneumonia, before embarkation. Between 40,000 and 50,000, 
not including men of the Cape Labour Corps and Cape Horse 
Transport, were sent to England for duty in France and else- 
where from this mobilization camp. These were in addition 
to recruits examined for despatch to the East African 
Expeditionary Force, both as fighting troops and followers. 

In January, 1917, hospital ships with sick and wounded 
from German East Africa commenced to arrive in South Africa 
and continued throughout the war to bring convoys to Cape 
Town and Durban, where they were distributed to other 
hospitals and convalescent camps organized by the Union 
Ministry of Defence in Natal and in the Transvaal both for 
white and coloured native troops. 

The distribution of Union convalescents arriving in these 
convoys differed from that of the Imperial sick and wounded. 
The latter were transferred to the general hospitals on disem- 
barkation, but the former as a rule, if repatriated on account 
of malaria, were dispersed to their homes throughout the 
Dominion owing to the shortage of hospital beds. The treat- 
ment of these men proved, as was to be expected, unsatisfactory. 
It became necessary to recall many of them and admit them 
to hospitals, and this led to a commission being appointed 
in July, 1917, by the Minister of Defence to report upon 



316 



MEDICAL HISTORY OF THE WAR 



the provision of hospital accommodation throughout the 
Union. 

The A.D.M.S., Cape Peninsula, who, as noted, was S.M.O. 
of the Imperial troops, accompanied the commission. The 
Government accepted the report of the commission, which 
recommended that 11,000 beds should be provided in South 
Africa for the sick and wounded from East Africa, and that 
a hutted hospital should be constructed at Durban in place 
of the marquees, which appear to have rotted in the climate 
there within three months. Colonel P. G. Stock was recalled 
from France to undertake the necessary organization at the 
Imperial expense. There were at that time 6,390 hospital 
beds available in the Union, exclusive of 2,000 in a con- 
valescent camp at Pretoria, but this accommodation was quite 
insufficient for the numbers returning from East Africa. The 
erection of the new hutted hospitals was proceeded with and 
such was the expedition used that most of the huts were 
ready for occupation when large numbers of sick and wounded 
arrived at the end of 1917. Consequently the system of sending 
malarial patients to their homes had not again to be adopted. 
A reorganization of the hospital accommodation then became 
possible and certain convalescent hospitals were practically 
closed down by May, 1918. The Union authorities referred 
the question of increase of hospital accommodation generally 
to the War Office, and the matter was left to the decision 
of Major-General Pike, A.M.S., who was to visit South Africa 
on completion of special duty in connection with the medical 
services in German East Africa. Major-General Pike held a 
conference on the subject at Cape Town on the 14th May, 
1918. The hospital accommodation at the time was as 
follows : 





Number of 








Equipped Beds. 






Designation. 




Locality. 


Remarks. 








White 


Coloured 








Troops. 


Troops. 






No. 1 General Hospital . . 


1,040 


_ 


Wynberg, Cape Town 


Capable of expansion to 










1 ,600 under canvas. 


No. 2 General Hospital . . 


990 


50 


Maitland, Cape Town 


Capable of additional ex- 
pansion of 1,500 under 










canvas. 


No. 3 General Hospital . . 


520 





Durban . . 


Capable of expansion to 










500 under canvas. 


Section 


100 





Addington, Durban . . 


20 beds for officers or 










sisters. 


No. 4 General Hospital . . 


1,485 


30 


Roberts Heights, Pre- 


35 beds for officers. 








toria 




No. 6 General Hospital . . 


553 


24 


Potchefstroom 


21 beds for officers or 










sisters. 


No. 7 General Hospital . . 


100 


140 


Woodstock, Cape Pen- 


For venereal patients. 








insula 




Fort Knokke Hospital . . 





400 


The Docks, Cape Town 


A disused military hos- 










pital. 


No. 1 Auxiliary Hospital. . 


130 





Trovato, Cape Town . . 


Voluntary hospital. 



SOUTH AFRICA 



317 



Designation. 


Number of 
Equipped Beds. 


Locality. 


Remarks. 


White 
Troops. 


Coloured 
Troops. 


No. 2 Auxiliary Hospital . . 


20 




Balgarthen,Cape Town 


Voluntary hospital for 










officers. 


No. 3 Auxiliary Hospital . . 


16 





Waterloo House, Cape 


Voluntary hospital. 








Town 




No. 4 Auxiliary Hospital. . 


220 





Newlands House, Cape 


Voluntary hospital. 








Town 




No. 8 Auxiliary Hospital . . 


25 





La Belle Alliance, Cape 


Voluntary hospital for 








Town 


officers. 


Congella V.A.D. Hospital 


38 





Durban 


St. John V.A.D. 


Kings House Auxiliary 


50 





Durban 


For officers or sisters. 


Hospital 










Caister House Auxiliary 


73 





Durban 


Red Cross hospital. 


Hospital 










Grassmere Auxiliary Hos- 


17 




Durban 


For officers or sisters. 


pital 










Stationary Hospital 


200 





Epsom Road, Durban. 




Jacob's Hospital . . 





500 


Durban. 




Epidemic Hospital 


150 





Durban 


Quarantine hospital. 


Tempe Hospital . . 


204 





Bloemfontein 


Capable of expansion to 










1 ,000 under canvas. 


Wanderers Hospital 


200 





Johannesburg 


12 beds for officers. 


Civil Hospital 


122 





Maritzburg. 




Civil Hospital 


19 


32 


Kimberley. 




Combined Cape Corps 





421 


Kimberley. 




Hospital 










No. 1 Convalescent Camp 


2,045 





Roberts Height Pre- 


45 beds for officers. 








toria 




No. 2 Convalescent Camp 


430 





Maritzburg. 




No. 3 Convalescent Camp 


425 





Durban. 




Jacobs Convalescent Camp 





1,500 


Durban. 




Combined Cape Corps 





510 


Kimberley. 




Convalescent Camp 










Total .. 


9,154 


3,207 







Any further increase of hospital accommodation was con- 
sidered unnecessary, and, on Colonel Stock's recommendation, 
in order to set free medical personnel for service elsewhere, 
Major-General Pike agreed on behalf of the War Office to 
considerable reductions in the existing accommodation. The 
convalescent camp at Roberts Heights, Pretoria, for example, 
could be reduced from 2,000 to 600 beds, the native con- 
valescent camp at Jacobs, Durban, from 1,500 to 500, No. 6 
General Hospital at Potchefstroom from 600 to 300, the 
native hospital at Jacobs from 500 to 300. Some other 
minor reductions were also sanctioned. 

The approximate number of sick and wounded treated in 
the general hospitals of the Cape Peninsula during the war 
period, exclusive of large numbers treated in convalescent 
camps and depots, was 60,000, of whom the majority were 
troops from East Africa and other theatres of war. The 
number treated in other hospitals of the Union was some 
60,000 more. The D.M.S. of the Union always consulted the 
Imperial authorities regarding the disposal of sick and wounded 
of the Imperial Forces, who contributed a considerable per- 
centage of these admissions. 



318 MEDICAL HISTORY OF THE WAR 

Upwards of 750,000 troops on transports and other vessels 
are estimated to have called at or embarked at South African 
ports during the war. The medical services were concerned 
in dealing with the medical and sanitary arrangements con- 
nected with them. Owing to the shortage of shipping, which 
began to be experienced in January, 1916, in embarking troops 
for the United Kingdom at Cape Town, much difficulty was 
experienced in arranging for suitable hospital and other sani- 
tary conditions on board. Comfort had to be sacrificed in order 
to transport the maximum number. The necessity of darken- 
ing the ships during the night interfered with ventilation, 
a matter of much importance in passing through the tropics. 
In order, however, to maintain suitable hospital accommo- 
dation on board, especially in the event of infectious diseases 
occurring, it was the practice at Cape Town to disembark all 
sick before the ships sailed. Thus 146 cases of measles and 
mumps were landed in December, 1916, from the " Suevic," 
which arrived with troops from Australia. The hospital 
accommodation allowed in transports was 3 per cent, of the 
troops on board. This was found inadequate for transports 
conveying troops returning from service in East Africa and, 
for them, hospital accommodation was increased and the 
numbers carried reduced by disembarking some of the men. 
Altogether 1,000 patients were landed from transports touching 
at Cape Town between October, 1916, and the date of the 
Armistice. 

In addition to the sick and wounded landed from 
hospital ships plying between German East Africa arid the 
Cape base, many were also transferred from Mesopotamia 
and India to the Cape, because of certain military advantages 
in using a base in South Africa for sick and wounded from 
these theatres of war. As there was no regular service of 
hospital ships between South Africa and England many of 
these patients were kept for a considerable time in the Cape 
Town hospitals. Consequently there were periods after the 
hospitals had been reduced when they became congested, 
but the difficulty was met by the transfer of convalescents 
to England by ordinary transports. On these occasions 
additional hospital accommodation was arranged on board 
the transports and female nurses were added to the hospital 
staff in many cases. The Australian and New Zealand hospital 
ships returning empty to England were also most useful in 
relieving the Cape Town hospitals of sick and wounded 
waiting trans-shipment. 

The sick and wounded who arrived from East Africa were 
generally in a very debilitated condition owing to recurrent 



SOUTH AFRICA 319 

attacks of malaria followed by anaemia and cardiac compli- 
cations. The climatic conditions and abundance of food, 
fresh fruit and vegetables obtainable at Cape Town caused 
rapid improvement in their health. 

Outbreaks of infectious disease were of an insignificant 
character amongst the troops in the Cape peninsula until 
the end of September, 1918, when an epidemic of influenza, 
"declared to be the most sudden, severe and malignant pesti- 
lence ever experienced in the country, fell upon the Union 
of South Africa and was the cause of many thousands of 
deaths." The garrison of the Cape Peninsula suffered equally 
with the general public. The first cases were mild, but as the 
epidemic progressed there was an increasing tendency to fatal 
complications. 1,323 European soldiers were admitted to 
hospitals from the garrison of the peninsula, and 20 from 
transports ; 91 died. There were also 351 admissions and 
7 deaths amongst coloured troops, in addition to many 
serious cases amongst the families of the garrison. Vaccine 
inoculation was given a trial, and although no exact con- 
clusion was reached as to its value the disease appears to have 
been modified and the incidence and severity of lung complica- 
tions lessened. Several of the local civil authorities applied 
to the military medical authorities for assistance during the 
epidemic. Hospitals under canvas were organized for them 
by Colonel Hewat, the A.D.M.S., and medical officers were 
appointed to visit them daily. 

An interesting incident in connection with this disastrous 
epidemic is that during it the Japanese cruiser "Nukata" 
was in Simon's Bay and afterwards in Table Bay, but entirely 
escaped infection. The preventive measures carried out by 
the Japanese were of a drastic character and included stoppage 
of shore leave or of visitors from shore, the wearing of masks 
by men necessarily sent to shore on duty, disinfection of 
everything taken on board, and inoculation with anti-influenza 
vaccine. Vegetables from the shore were washed and exposed 
to sunshine, bread was exposed to heat in kitchen ovens, meat 
and fish were exposed to the air and the covers on them 
changed on the pier, newspapers and letters were sprayed with 
formalin and dried in the sun ; men returning from shore duty 
gargled with 1 in 10,000 solution of corrosive sublimate and 
cleaned their clothing and boots with a 3 per cent, solution 
of carbolic acid on the pier before going on board. They were 
given formalin " tabloids " to use on shore, and instructed to 
avoid crowds. The crew gargled with salt after every meal 
and with corrosive sublimate or boracic acid before turning 
in. Temperatures were taken every day and any signs of 



320 MEDICAL HISTORY OF THE WAR 

inflammation of naso-pharyngeal passages searched for and the 
cases isolated. All table dishes were boiled after use, and, at 
the height of the epidemic on shore, provisions from town 
were stopped and only tinned meat and fruits used. 

Cerebro-spinal meningitis occurred on Australian and other 
transports calling at Cape Town and caused considerable 
anxiety, as no case had occurred amongst the civil popula- 
tion for many years. Major Douglas Pullon, S.A.M.C., was 
appointed to carry out investigations at the Government 
bacteriological laboratory, under Lieut. - Colonel Robertson, 
the Government bacteriologist. On any suspicious case being 
reported he visited the ship, had suspected cases removed to the 
city infectious hospital, and examined the men on board in order 
to detect carriers. All this work was carried out under difficult 
conditions, but the bacteriological reports were of great value 
to the military medical administration. Close contacts of 
cases were segregated until the bacteriological report on them 
was received, and those found to be positive carriers were 
removed to the infectious hospital and detained until at least 
two negative swabs were obtained. Eight hundred and forty- 
four contacts were examined and 74 found positive. In addi- 
tion, 310 non-contacts with catarrhal conditions of the throat 
were also examined* and six found positive. 

The number of cases of the disease occurring on transports 
before their arrival at Cape Town was 126 between June, 1916, 
and October, 1917. Of these, 51 acute cases were treated in 
Cape Town ; others of the 126, who had not died at sea, had 
been landed at Durban. Three convalescent cases and ten 
suspected cases, which did not, however, develop the disease, 
were also landed at Cape Town. Eighty-two carriers were 
isolated and treated in the city infectious hospital, their 
average stay being thirty-seven days before they became 
bacteriologically free. The precautions adopted proved effec- 
tive and prevented the introduction of the disease amongst 
the garrison and civil population. 

In March, 1917, the Union Government agreed to pay the 
whole cost of the hospitals in the Cape peninsula, including the 
cost of treatment of Imperial sick and wounded in them ; and in 
consequence of this the D.M.S. of the Union appointed Union 
medical officers as A.D.sM.S. of the peninsula and Durban, 
Colonel J. Hewat being appointed to the former post and 
Lieut. -Colonel Whitestone to the latter. Lieut.-Colonel Wright, 

* This was done at the instance of the civil Medical Officer of Health. 
The result of the examination of non-contacts was transmitted by wireless 
telegraphy to the ships, should the ship have sailed before the examination 
was completed. 



SOUTH AFRICA 321 

R.A.M.C., who had up to this time acted in the dual capacity 
of A.D.M.S. under the Union D.M.S. and S.M.O for Im- 
perial troops, was thus relieved of responsibility regarding the 
administration of the hospitals, but not as regards the disposal 
of the Imperial sick and wounded in them. He also retained 
responsibility for all duties connected with transports. It was 
accordingly necessary to define clearly the duties of the S.M.O. 
responsible to the General Officer Commanding the garrison 
and to the War Office, as distinct from those of the A.D.M.S. 
responsible to the D.M.S. and Union Minister of Defence. 

Much assistance was given to the medical authorities by 
voluntary workers. A committee was formed on the outbreak 
of war at Cape Town to raise funds for the provision of certain 
auxiliary convalescent hospitals in the peninsula both for 
officers and men. It was this committee which chartered the 
"Ebani " and converted it into a hospital ship for service in 
German South-West Africa. Two large private houses, capable 
of accommodating 90 patients each, were taken over as auxiliary 
hospitals, and other convalescent homes opened. The expenses 
of these were met by public subscriptions. They were placed 
under the command of Colonel Stanford ; military medical 
officers took medical charge of the patients. The Cape of 
Good Hope Red Cross Society also raised funds to supply 
comforts to troops proceeding on active service, to hospital 
ships, transports carrying invalids from Cape Town, and to 
military hospitals in the field during the South-West African 
and East African campaigns ; for the establishment of the 
South African hospital at Richmond, for South African medi- 
cal units in France, and for other theatres of war.* 

The S.M.O. of the Imperial Services recorded certain points 
of administrative importance as the result of his experience in 
the dual capacity of responsibility to the G.O.C. of the Imperial 
command and to the D.M.S. of the Defence Ministry of the 
Union. He considered that there should be in similar circum- 
stances an Imperial military hospital directly under R.A.M.C. 
administration and staffed by R.A.M.C. personnel, although 
it should be noted that such personnel was not available ; 
that there should be a military infectious diseases hospital for 
the reception of infectious cases from transports, as well as 
from the garrisons ; that the hospital accommodation on 
transports on long voyages should be increased, and 
encroachments on deck space reduced ; and that the Union 
regulations affecting the administration of military hospitals 

* A Cape coloured corps formed part of General Allenby's force in 
Palestine. It was accompanied by a medical personnel from the South 
African Medical Corps. 

(1735) Y 



322 MEDICAL HISTORY OF THE WAR 

should be more in agreement with the general principles laid 
down in Army Medical Service Regulations. He also raised a 
point of interest in connection with European troops serving in 
a tropical campaign. He found that the average percentage of 
men returned to duty in German East Africa after being 
invalided to the Cape was 60 per cent, amongst those who had 
been in East Africa for one year only, 40 per cent, of those 
who had been there from one to two years, and 12 per cent, of 
those who had been over two years. From this he concluded 
that European troops should not be kept on active service in 
tropical climates for more than eighteen months without relief. 
The general sanitary work at the base was carried out by 
sanitary inspectors in association with the civil medical officers 
of health and Defence Force officers appointed for sanitary 
duties from time to time. Colonel Buist during the time he 
was senior medical officer noted the exceptionally small 
amount of sickness amongst those returning from the German 
South- West African campaign. The hospital ship "Ebani" 
which was equipped for 300 or 400 beds generally came back 
only partially filled. He considered that the comparative 
immunity of the troops was attributable to a great extent to 
the generous use of arsenite of soda, which was used as a 
solution for the destruction of flies and sprayed round kitchens, 
animal kraals and horse lines. In the Cape Peninsula, branches 
of eucalyptus or other trees with large leaves were hung 
in every tent, cookhouse, and latrine, and sprayed twice weekly 
with the solution. In kraals and horse lines it was sprayed over 
the ground with a watering-can. The solution was composed 
of 5 Ib. arsenite of soda, 5 Ib. of sugar and 10 gallons water, 
and coloured with cochineal. Its value in removing flies 
was specially observed in the camps at Liideritzbucht, the base 
in South-West Af rica,where weather conditions and innumerable 
horse lines were favourable to their prevalence. Yet they were 
remarkably absent from tents, cookhouses, latrines, and camps 
generally at the time Colonel Buist visited the base in company 
with Lord Buxton, the Governor-General, and with the General 
Officer Commanding at Cape Town.* 



* See Chapter XXI, p. 346. 



CHAPTER XX 

THE MEDICAL SERVICES DURING THE OPERATIONS IN SOUTH- 
WEST AFRICA 

GENERAL NARRATIVE 

THE formation of the defence forces of the Union of South 
Africa had been authorized by an Act of the Union 
Parliament only in 1912, and time had not permitted of the 
organization of an effective medical corps, with officers, non- 
commissioned officers and men trained for active service, 
when the war broke out in August, 1914. 

A training school was in process of formation in connection 
with the only existing military hospital of the Union, under 
the command of Lieut. -Colonel G. H. Knapp, at the military 
schools at Tempe, Bloemfontein. An officer from the 
R.A.M.C., Captain B. A. Odium, had been seconded to act as 
chief instructor, but the first classes were to have been held 
only in September, 1914, when four medical officers who had 
been appointed to the permanent force staff were expected 
back from England, where they had been sent for training at 
the R.A.M.C. College and Depot. 

Citizen Force medical officers had also been appointed as 
assistant directors of medical services in ten military districts, 
and a small staff of non-commissioned officer instructors had 
been engaged ; but no mobilization plans had been prepared, 
and beyond a small amount for instructional purposes there 
was practically no medical equipment in store. 

The directing staff for medical services at Defence Head- 
quarters consisted of a staff officer, Major P. G. Stock, who 
was responsible to the Minister for Defence, a quartermaster 
for dealing with medical stores, Captain Cope, and a military 
clerk, Mr. Jones.* Shortly after the outbreak of war Major 
Stock was appointed Director of Medical Services and pro- 
moted to the rank of lieutenant-colonel and subsequently to 
that of colonel. 

When the news was received in Pretoria that war had been 
declared, the South African Government accepted responsi- 
bility for the defence of the Union in order to free the Imperial 

* Afterwards Captain Jones, S.A.M.C. 

(1735) 323 Y 2 



324 MEDICAL HISTORY OF THE WAR 

regular troops then stationed in South Africa for service in 
Europe. They also agreed, at the request of the Imperial 
Government, to send an expedition against German South- 
West Africa, the naval part being undertaken by the Imperial 
authorities and the military operations by the Union 
Government. 

These decisions threw a great responsibility and strain 
on Major Stock and the small staff at Defence Head- 
quarters, particularly as owing to the rapidity of mobilization 
nearly every available medical officer with any military ex- 
perience had immediately to be sent into the field. Personnel 
had to be found, equipment obtained, and organizations 
hurriedly built up and expanded to meet the pressing 
needs. 

By the end of August, 1914, practically the whole of the 
Imperial garrison had sailed, with the exception of two com- 
panies of the R.G.A., a field company of the R.E., and a few 
details in the Cape Peninsula. Amongst the latter Lieut. - 
Colonel Buist and about half-a-dozen other ranks of the 
R.A.M.C. had been specially retained, and during the campaign, 
as noted in the previous chapter, Lieut. -Colonel Buist acted 
as senior medical officer in the Cape Peninsula. 

On September 9th, 1914, the Union Parliament met in 
Extraordinary Session, and the action of the Government 
respecting hostilities in German South- West Africa was con- 
firmed by both the Senate and the House of Assembly. 

A short summary of the more important physical character- 
istics of the country in which the campaign was to be con- 
ducted will enable an appreciation to be made of the 
conditions with which the medical services, as well as all 
other troops, had to contend. 

The portion of the African continent then known as German 
South-West Africa covers more than 322,000 square miles 
and is situated between 11 and 26 east longitude and 17 16" 
and 29 south latitude. 

Portuguese Angola adjoins it on the north, the boundary 
being briefly the Cunene and Okavengo rivers. On the south, 
the northern bank of the Orange River forms the boundary 
with the Union of South Africa. The eastern boundary 
traverses the Kalahari Desert and follows the 20th degree 
east longitude until it meets the 22nd degree south latitude, 
along which it runs until the 21st degree east longitude is met. 
From this point northwards it follows the 21st degree east 
longitude, free access to the Zambesi being given by a strip 
of territory 20 miles wide. 

On the west is the South Atlantic ocean, but as the moisture 




H WEST AFRICA. 



OF HOSPITALS AND 



EVACUATION. 



K A I L A H A R I 




are 



OPERATIONS IN SOUTH-WEST AFRICA 325 

laden winds from the sea only precipitate rain when they 
strike the mountains inland, there is an intervening strip of 
burning waterless desert, covered near the sea with moving 
sand-dunes. These are succeeded farther inland by a hard, 
barren surface, which in turn gives place to the ravines of 
numerous watercourses, whose hidden waters make a few 
small oases at the foot of the hills but never reach the sea. 
Except where crossed by the valley of the Swakop River and 
the southern railway to Luderitzbucht, this desert strip 
presents a practically insuperable obstacle to the movement 
of troops. 

Strong winds from the west and south are frequent, raising 
a heavy sea and dangerous surf on the shore. The only 
harbours which could be utilized for military purposes were 
Luderitzbucht, Swakopmund, and Walfish Bay, the last a 
British possession, the entrance to which is about 12 miles 
south of Swakopmund. 

Luderitzbucht had a well-sheltered harbour, but no facilities 
existed for discharging vessels direct on to a quay. The port 
was entirely dependent for its water supply on condensers, but 
these were destroyed before the troops landed. 

Swakopmund, as a port, had little more than an open 
anchorage. The town covered nearly a square mile on the 
sandy shore north of the mouth of the brackish Swakop River, 
and was the terminus of the railway system which linked up 
the north and south of the country, and, like the terminus 
at Luderitzbucht, connected them with the sea. Walfish 
Bay had an excellent harbour with a well-sheltered anchorage, 
but the only water supply was obtained from brackish wells 
4 miles distant, and the only landing facility was a small 
jetty. The surrounding country for miles and miles pre- 
sented the appearance of unutterable desolation. 

In the interior, the country rises to a height of 3,000 or 
4,000 ft. Windhuk, the capital, is over 5,000 ft. above 
sea-level, and the Auas Mountains, immediately to the south, 
about 2,000 higher. 

Near the coast, and as far inland as the foothills of the cen- 
tral plateaux, the climate is very dry, though heavy fogs occur 
close to the sea. The rainfall varies considerably, but the 
country is poorly watered and the majority of the rivers, 
except in the height of the rainy season, flow underground. 

The water supplies are usually obtained from wells, but in 
the .coastal belt, except at Swakopmund, distillation of sea- 
water has to be resorted to. The deficiency of water was 
found, as had been anticipated, the chief difficulty in the 
movement of troops. 



326 MEDICAL HISTORY OF THE WAR 

The range of temperature is very great, but while high 
temperatures are recorded by day, the nights are usually 
more or less cool. 

The roads through the country can only be described as 
well-defined " tracks," and, though much of their surface was 
hard and good, it was always found that there were long, 
difficult stretches of heavy sand, rocks, or steep gradients. 
After rains large areas of the country become covered with 
grass. There is little forest, but in the interior a good deal 
of " park-like " open bush country is found covered with 
acacias and jungle thorn. 

The original plan of campaign for the military operations 
was for four columns, known as Forces A, B, C and D, to enter 
German territory simultaneously via Nakab, Raman's Drift, 
Liideritzbucht and Swakopmund. Liideritzbucht and Swakop- 
mund have already been described. Raman's Drift is on the 
Orange River, but owing to the difficulties of reaching it 
overland it was decided that the column advancing by it 
should first proceed by sea to Port Nolloth. 

A considerable amount of shipping had to be arranged for, 
but by the 2nd September the force which was to operate via 
Raman's Drift was able to sail. Its departure was hastened 
by the news that the Germans had commenced hostilities. 
A strong patrol of the German colonial forces crossed the 
border at Nakab and entrenched in Union territory about 
the 18th August, and on the 22nd August a skirmish 
occurred at Schuit Drift between a part of this patrol and 
some Afrikander refugees, who were escaping into Union 
territory. 

Force "A," which had sailed from Cape Town on the 2nd 
September and had landed under considerable difficulties at 
Port Nolloth and reached Sandfontein beyond Raman's Drift 
on the 25th September, was unable to make material progress 
against the enemy, and after suffering severe casualties was 
withdrawn. It had been accompanied by the Mounted 
Brigade Field Ambulance of the South African Mounted 
Rifles, with Lieut.-Colonel G. H. Knapp as its senior medical 
officer. No. 9 Mounted Brigade Field Ambulance was sent to 
it from Cape Town on the 29th September, but was unable to 
land at Port Nolloth until the 13th October on account of severe 
weather. It proceeded inland and was temporarily employed 
on hospital duties at Steinkopf, a station 61 miles from the 
coast, connected with it by a narrow gauge railway, and 
about 45 miles from Raman's Drift, across a waterless desert. At 
Steinkopf the chief difficulty was the high temperature, which 
reached 110 F. in the shade, and was in marked contrast with 



OPERATIONS IN SOUTH-WEST AFRICA 327 

the wet and cold weather at the Cape when the unit embarked. 
On the withdrawal of the force, No. 9 Mounted Brigade Field 
Ambulance proceeded overland for duty in Bloemfontein, and 
the small hospitals which had been established at Steinkopf, 
O'okiep and Port -Nolloth were closed, the casualties and 
remainder of the medical personnel being transferred by sea 
from Port Nolloth to Cape Town. 

Force " B " operations from Upington did not materialize 
and it was partly on this account that Force " A " had to be 
withdrawn for the time being. 

Force " C," which was intended in the first instance to 
capture Liideritzbucht, landed without opposition, as the 
Germans surrendered the town on the 18th September after 
destroying the water condensers. The " Monarch," however, 
had been specially selected as a transport for this expedition 
because it was fitted with condensers capable of condensing 
13,000 gallons of water a day, in addition to the 750,000 
gallons of fresh water carried in its tanks, and by this means 
water continued to be supplied. 

There was a well-equipped German hospital on Shark 
Island which was at once taken over by the medical services, 
and subsequently two other hospitals were opened in 
Liideritzbucht, one in the drill hall and the other in the 
Europaischer Hof. The hotel buildings proved unsuitable 
and were closed, extensions being made to the drill hall and 
the hospital on Shark Island. Afterwards these various 
sections were grouped together as No. 4 General Hospital. 

Skirmishing occurred on the outskirts of the town, but when 
the enemy retired to Garub and later to Aus, the question 
of repairing the railway line and obtaining sufficient supplies 
of water to enable the troops to cross the desert belt became 
the most pressing problem. Force " C," however, ceased to 
exist as a separate command on October 3rd, when Brigadier- 
General Sir Duncan Mackenzie arrived with Force "D," which, 
instead of proceeding as originally intended to Walfish Bay, had 
been diverted to Liideritzbucht, having sailed from Cape Town 
on the 30th September. The two forces " C " and " D " were 
then amalgamated and were designated the " Central " force. 
Lieut.-Colonel Odium and Major G. D. Maynard had been 
appointed A.D.M.S. and D.A.D.M.S. of the force respectively 
and accompanied General Mackenzie. They were transferred, 
however, to the administrative medical charge of a new force, 
the Northern Force, which was organized in December to 
proceed to Walfish Bay. Their places with the Central 
Force were then taken by Lieut.-Colonel G. H. Knapp and 
Major L. G. Haydon. 



328 MEDICAL HISTORY OF THE WAR 

The Central Force at Liideritzbucht was thus the only 
column in German South- West Africa until the end of 1914 r 
and, until new forces for an advance from the south and 
east, and a Northern force could be organized, its operations 
were confined to preparing for its subsequent advance across 
the desert from Liideritzbucht. 

The most pressing question was the provision of water 
and conveying it to the troops, who suffered much from the 
heat and terrible sand-storms, on the outskirts of the town. 
Additional condensing plant was erected and a large reservoir 
built, but until these works could be completed the troops 
were dependent on water brought on shore from the transports. 
It soon became obvious, however, that animal transport was 
useless owing to the heavy sand, and that an advance across 
the desert could only be made by reconstructing the railway 
which the enemy had destroyed as he retired. 

Directly material could be sent up from Cape Town the 
work of repairing the railway line was pushed forward and 
protecting blockhouses constructed. Progress at first was 
slow, but quickened up when a Railway Pioneer Regiment 
was organized and trained men became available. In the 
first section of the line the constantly shifting sand-dunes 
caused great difficulties, but were eventually overcome by 
pegging down matting over large areas of the dunes. 

The country in the vicinity had continually to be patrolled, 
but by the 15th December the force had advanced to and occu- 
pied Tschaukaib. At Tschaukaib the dust and heat were worse 
than anything so far experienced. The sand-storms were 
terrific and during the day the temperature in the bell-tents, 
which were the only shelter available, frequently reached 
127 F. The Central Force troops remained at Tschaukaib 
until the 19th February, 1915, and from their position could 
see the mountains at Aus where the Germans were strongly 
entrenched, with ample supplies of water behind them. A 
field hospital was opened at Tschaukaib by two sections of 
No. 1 Field Ambulance, but in spite of the heat and the dust 
the admission-rate for sickness was low. Together with the 
rest of the camp this hospital was constantly bombed by 
enemy aeroplanes, against which there was then no effective 
reply. Little damage was done, and on the whole the diversion 
helped to maintain the spirit of the troops. As the general 
conditions, however, were most trying, units in turn were 
sent to the coast for a short rest at Liideritzbucht. There the 
temperature was much lower, the men were able to bathe, 
and the change did much to maintain their health. 
Any advance from Tschaukaib to Aus necessitated a 




SAND DUNES. SOUTH-WEST AFRICA. 




INFANTRY ADVANCING OVER THE DESERT NEAR POMONA, 

LUDERIT ZBUCHt. 



To faff page 328. 



OPERATIONS IN SOUTH-WEST AFRICA 329 

sufficient supply of water being carried for man and beast. 
Moreover if, when an advance took place, the troops failed 
to carry the position, sufficient water had to be available for 
the retreat ; and it was not until the middle of February, 1915, 
that anything more than a reconnaissance beyond Tschaukaib 
could be attempted. By that time the Northern Force which 
was to operate from Walfish Bay had occupied Swakopmund, 
and a Southern and an Eastern Force were advancing from 
the Orange River and across the Kalahari desert. 

On the 22nd February, 1915, Garub was occupied by the 
Central Force and the advance to Aus assured. The great 
difficulty had been to obtain a water base forward, and although 
water-boring had been carried out at Tschaukaib and half- 
way between it and Luderitzbucht the results were un- 
satisfactory. At Garub, however, a good supply of water 
was at once obtained, and three days after the position was 
occupied drinking water from the bore-holes was available. 

Tschaukaib had been hot, but Garub was hotter, and during 
the day the temperature in the bell-tents was seldom below 
137 F. Sun-stroke, however, was practically unknown. The 
favourite order of dress was a helmet with boots and socks. 
A field hospital was opened at Garub by a section of No. 1 
Field Ambulance ; other field ambulances were held in reserve 
for the subsequent advance to Aus, the first position which 
the Germans held in force across the desert belt. 

On the 30th March the advance took place. In the mean- 
time the Eastern Force had arrived at Rietfontein and the 
Northern Force had attacked and captured Riet. Probably 
in consequence of these movements the enemy had been 
unable to continue his concentration, and Aus was found 
to have been evacuated. The wells, however, had been 
poisoned, and the troops suffered severely from thirst ; but 
the situation was relieved by the arrival of Corporal Hippert, 
of No. 1 Field Ambulance, with 17 water-carts which he had 
volunteered to bring through the extensive but unmarked 
mine-field in front of Aus. By the 22nd April railway com- 
munication between Luderitzbucht and Aus was open. 
Previously Garub had been the farthest point reached by 
train. The desert belt had now been crossed, and water 
and grazing and also rough roads for the passage of transport 
became available. 

By the 14th April the mounted troops were concentrated 
at and in the vicinity of Aus, and the advance of the Central 
Force then entered on a new phase. Hitherto the work 
had been essentially performed by the infantry, but after the 
capture of Aus the mounted troops took the lead. A flying 



330 MEDICAL HISTORY OF THE WAR 

column was formed, No. 5 Mounted Brigade Field Ambulance 
being attached to it. The column advanced by Kuibis to 
Bethany and Beersheba, 150 miles from Aus, being in touch 
with the enemy from time to time during the march. 

On the 24th April General Mackenzie moved out of Beer- 
sheba and eventually came up with the main force of the 
enemy at Gibeon. An engagement was fought on the morning 
of the 27th April ; a number of prisoners and considerable 
stores were captured and the German Southern Force was 
finally defeated and put to flight. To move the wounded was 
impossible, and Colonel Knapp hastily improvised a hospital 
in Gibeon. Four or five days after the column had left Aus 
a wireless message had been sent back to No. 1 Field Ambu- 
lance to follow with as much equipment as possible. Major 
Pratt Johnson with two officers and 70 non-commissioned 
officers and men at once started. Their transport consisted 
of a number of water-carts, seven ambulance wagons, ten 
general service wagons and several Scotch carts with equipment 
and stores. On one occasion the mules could not be watered 
for thirty hours, but they reached Gibeon in seven and a half 
days. Some of the personnel were employed in the hospital 
at Gibeon, and as soon as possible nurses and other personnel 
were brought up. Later, when they were able to travel, the 
casualties were evacuated to Keetmanshoop, then to Liideritz- 
bucht, and finally sent down by hospital ship to Cape Town. 

The force known as the Southern Force concentrated in 
the north-west district of Cape Colony under Colonel J. van 
Deventer, with Lieut.-Col. A. B. Hinde, a retired officer of 
the R.A.M.C., as his A.D.M.S. Raman's Drift was occupied 
by troops of the left wing of the force on the 12th January, 
1915, but on the 24th January the enemy attacked the right 
wing at Upington and in the fighting which ensued a section 
of No. 1 Mounted Brigade Field Ambulance did particularly 
efficient work in attending to the wounded. On the 3rd 
February the left wing was engaged against the German 
advance posts near Sandfontein, and early in March Nabas 
was taken by the troops advancing on the right under 
Colonel van Deventer. No. 1 M.B.F.A. had been attached 
to this column and a fifty - bedded field hospital was 
opened in some buildings at Ukamas, some 10 miles east 
of Nabas. The ambulance eventually moved to Kalkfontein 
and its personnel, who had been employed in the hospital 
at Ukamas, was replaced by other medical officers and 
personnel and a few nursing sisters. The mountainous nature 
of the country between Kalkfontein and Keetmanshoop, 
known as the Karas ranges, rendered the further advance 



OPERATIONS IN SOUTH-WEST AFRICA 331 

of the Southern Force difficult. Colonel van Deventer had 
pushed forward direct to Kalkfontein and his left column 
pushed up from Raman's Drift. Kalkfontein became the 
temporary headquarters of the Southern Force on the 5th 
April, and on the llth April General Smuts, the Union Minister 
of Defence, arrived. The Central, Southern, and Eastern Forces 
were then grouped under his command as a Southern Army. 

Kalkfontein was the rail-head of the German military 
system in the south, but until railway connection could be 
established with Luderitzbucht and rolling stock became 
available, casualties had to be evacuated by ambulance wagons 
and empty supply wagons through Ukamas, Nakab, and 
Langklip to Malopo, to which railway communication from 
Upington had been extended. Seeheim, which was the junction 
of the railway line from Kalkfontein with the line from 
Keetmanshoop to Luderitzbucht, was entered on the 19th 
April, and Keetmanshoop was formally surrendered by the 
Burgomaster to the Union Forces on the 20th April. 

The greatest difficulties in this advance of the Southern 
Force were in connection with water supplies and transport. 
As the enemy retired he destroyed the wells and poisoned 
the water, and no railway then existed. In September, 1914, 
the rail-head of the line from De Aar in Cape Colony had only 
reached Prieska, but it was quickly advanced to Upington 
on the Orange River, although supplies for Upington, which 
lay on the right bank, had to be ferried across. Owing to 
heavy rains the river soon became more than a mile wide, 
and a temporary bridge was built. After the country had 
been cleared of the enemy, the line was carried through to 
Kalkfontein and thus joined up with the coast at Luderitzbucht 
through Seeheim. 

The evacuation of the sick presented a serious problem, 
and casualties had often to be carried forward in the ambulance 
wagons attached to units. Hospitals had been opened at 
Prieska and De Aar and wounded and sick were brought down 
to them by ambulance train. As soon as possible, however, 
the medical base was advanced to Upington, where a tem- 
porary hospital was opened until it was replaced by No. 7 
Stationary Hospital. After the Southern Force had reached 
Kalkfontein a clearing hospital was established at Kanus 
on the southern slopes of the Karas range and on the line of 
railway north-west of Kalkfontein. 

The Eastern Force was mobilized on the 4th January, 1915, 
under the command of Colonel C. L. A. Berrange, with 
Lieut. -Colonel J. Mackenzie as A.D.M.S. It was accompanied 
by No. 10 Mounted Brigade Field Ambulance, an improvised 



332 MEDICAL HISTORY OF THE WAR 

hospital unit, a water-boring party, and other details. It 
concentrated at Kuruman. Kheis on the Molopo River was 
occupied as a protection against a flank attack. The advance 
into the enemy's country had to be carried out across the 
Kalahari desert. Scouts, mounted on camels, were watching 
the border near Rietfontein and some skirmishing occurred 
at Witkrans early in February. Water-boring parties had been 
pushed forward as far as Witkrans but the enemy obliged 
the advance section to retire and destroyed the wells. 

The main column left Kuruman on the 6th March and for 
the greater part of 600 miles they marched through desert. 
A troop of Kalahari Horse pushed across some 111 miles of 
waterless country. The remainder of the column moved 
forward a squadron at a time owing to the shortage of water. 

On the 15th April the Force reached Kiriis West after 
skirmishes at Rietfontein and Hasuur and pushed on and 
captured Kabus, which Colonel Berrange occupied with the 
whole of his column on the evening of the 20th April. After 
the occupation of Kabus the advance was continued to 
Daberos, which was captured on the 28th April, and the 
Force rested for the first time since leaving Kimberley. 

The Eastern Force, as such, subsequently took no further 
part in the campaign. Its operations, as may be surmised 
from the nature of the country, had been carried on under 
conditions of exceptional difficulty. The physique of the 
men was good, and they stood the hardships of thirst, short 
rations, and continuous marching well. Beyond an outbreak 
of measles at Kimberley and Kuruman there was practically 
no sickness. Transport was mainly by oxen and ox-wagons. 
Where water was not available the oxen existed on tsama, 
a desert melon on which the few natives found in the country 
have frequently to rely. 

The water-boring sections succeeded in opening up water 
in wells and bore-holes and erecting storage tanks, without 
which the force could never have penetrated the desert. The 
111 miles of dry belt were crossed by utilizing motor cars to 
carry a supply of water forward for 40 miles, and establishing 
a second depot 41 miles farther west which the cars supplied 
from Witkrans. 

Fortunately some heavy rains fell in Cape Colony and caused 
a fall in temperature, but the great heat at first, followed by 
cold, windy weather, was trying both to men and animals. 

Generally speaking, the country traversed was comparatively 
flat. In parts the sandy soil carried a little grazing ; some 
bush and a few trees were found in the vicinity of river-beds 
and at rare intervals a water- hole. A few scattered kopjes, 




MOTOR CAR EMERGING FROM THE BED OF THE GREAT FISH RIVER. 







A WATER-HOLE IN THE DESERT. 



To fact page 332. 




WARD ON HOSPITAL SHIP "EBANI." 



To face page 333. 



OPERATIONS IN SOUTH-WEST AFRICA 333 

miles of sand-dunes, some large pans generally dry and salt 
extending over miles, with the intervening country covered 
with pebbly stones and sand, complete the picture. Reptiles 
were numerous. Several men were injured by scorpions and 
several horses and oxen killed by snakes. 

The organization of the medical services presented many 
difficulties, and Major Egerton Brown, the D.D.M.S., was 
sent from Defence Headquarters to confer with Colonel 
Berrange and his A.D.M.S. regarding the arrangements, and to 
inspect the line of route as far as possible. No. 10 M.B.F.A. 
was reorganized and a special hospital unit formed. Hospital 
accommodation was arranged at Kimberley, chiefly at the 
Kimberley Hospital, and a fifty-bedded hospital, expanded by 
tentage, was established at Kuruman in the buildings of 
the Moffat Institution. 

When the column moved out of Kuruman a small field 
hospital was opened at Mopeppa. As the troops advanced 
it was moved to Rietfontein and later to Kabus. The hospital 
at Kuruman was then closed and the equipment, nurses and 
other personnel pushed forward in wagons and motors to 
Keetmanshoop. 

In addition to the medical personnel with each regiment 
an ambulance wagon was attached to the larger units, but the 
country was unsuitable for mule transport and a small but 
efficient service of motor ambulance cars was organized by 
Captain Grainger, S.A.M.C. At Kabus they proved par- 
ticularly useful in clearing the wounded. They were also 
sent on to the Central Force after it had captured Gibeon 
and were used for evacuating sick and wounded to 
Keetmanshoop. In the first stages of the advance of the 
Eastern Force casualties were evacuated to Mopeppa, Kuruman 
and Kimberley, later to Kabus, and then to Keetmanshoop. 
When the railway line was open from Keetmanshoop, 
ambulance coaches were employed to evacuate the sick to 
Luderitzbucht, and thence by hospital ship to Cape Town. 

At the beginning of December preparations were renewed 
for landing a Northern Force at Walfish Bay. It was known 
that General Botha, who had assumed the duties of Com- 
mander-in-Chief, would accompany this force and, in addition 
to infantry, mounted and other units, a number of commandos 
were specially raised. 

The first portion of the force under the command of Colonel 
Skinner sailed from Cape Town on the 22nd December. The 
hospital ship " Ebani " was already anchored in Walfish 
Bay, and some of the accommodation on board had been 
utilized to carry the personnel of No. 2 Field Ambulance 



334 MEDICAL HISTORY OF THE WAR 

and No. 2 M.B. Field Ambulance. It had been sent to 
Walfish Bay by the Director of Medical Services to deal with 
possible casualties at the time of landing and to act as a base 
hospital until the necessary preparations could be completed 
on shore. No opposition, however, was experienced, and the 
landing was effected on Christmas Day. 

Dispositions having been made for the defence of Walfish, 
the most pressing question was the supply of water. Wells 
existed about 4 miles from the settlement, but the plant 
had been destroyed and the water polluted by the enemy. 
This possibility had been foreseen and a large supply of water 
had been brought up in the ballast tanks of the transports. 
The water was rapidly transferred to the shore and as soon 
as possible wells were opened up and water pumped to the 
camp. Unfortunately the well water was so brackish that 
it had to be mixed with the water brought from Cape Town 
before either men or animals could use it. A tent hospital 
was erected by No. 2 Field Ambulance at a convenient distance 
from the landing place, but difficulties were constantly ex- 
perienced owing to water being reached about 2 ft. below 
the surface. The sand was eventually rolled into fairly firm 
ground, the site fenced, electric light and water laid on, and a few 
huts erected for X-ray plant, dispensary, and other accessories. 

On the 13th January, the force under Colonel Skinner, accom- 
panied by No. 2 M.B.F.A., made a night reconnaissance towards 
Swakopmund. The only possible route lay along the beach, 
and as the track approached the town it narrowed considerably. 
Here many land mines had been laid but fortunately few 
casualties occurred and the small enemy force speedily retired. 
The town was found to be abandoned and a temporary hospital 
was opened in it by " B " Section of No. 2 M.B.F.A. Skir- 
mishes occasionally occurred with enemy patrols, but these 
never assumed such proportions as to hinder the work which 
was being done in preparation for the advance. As a port 
Swakopmund was practically useless, but railway material 
and locomotives had been shipped from Cape Town and a 
line was laid from the landing place at Walfish Bay. Before 
leaving Swakopmund the Germans had poisoned with arsenic 
the wells from which the water supply was drawn. The arsenic, 
however, was detected, and although this added to the 
preliminary difficulties no casualties occurred. 

In the meantime reinforcements, transport and stores were 
constantly arriving, and No. 3 General Hospital under Lieut.- 
Colonel R. P. Mackenzie was established in buildings at 
Swakopmund. On the llth February General Botha arrived 
and took over the command of the Northern Force, to which, 



OPERATIONS IN SOUTH-WEST AFRICA 335 

as already noted, Colonel B. A. Odium had been appointed 
as A.D.M.S., and Major G. D. Maynard as sanitation officer 
and D.A.D.M.S. A number of mounted brigade field ambu- 
lances were with it, namely Nos. 2, 6, 7, 8, 9, 12, and 21. 

On the 22nd February General Botha moved out from 
Swakopmund with the mounted troops and the country round 
was cleared. At places the water had again been poisoned, but 
a good supply was obtained from a farm in the valley of the 
Swakop river, 

On the 19th March a strongly held position at Riet was 
captured and some of the mounted brigade field ambulances had 
their first experience of a prolonged engagement, which lasted 
from dawn till dusk. No. 7 M.B.F.A. under Majors van 
Coller and Murray quickly adapted themselves to the difficult 
conditions of working with mounted troops. Leaving the tent 
division to open out, the bearer division went forward, and by 
taking advantage of the ground gradually concentrated the 
ambulance wagons in a kloof. Working from the cover afforded, 
by sun-down they had collected all the wounded and transferred 
them back by motor ambulance cars to the tent division. 
Assistance was then given to the wounded collected by No. 9 
M.B.F.A. and provision was made for their temporary reception 
at Husab. At Husab No. 2 M.B.F.A. established a field hospital 
and clearing station from which the casualties were gradually 
sent back to No. 3 General Hospital at Swakopmund. 

Owing to transport difficulties full advantage could not at 
the time be taken of the success at Riet, and the route for 
the further advance was carefully considered. From Swakop- 
mund two lines ran into the interior the Otavi Railway and 
the Swakopmund-Karibib section of the State Railway. 
Both were narrow, 2 ft. gauge lines, but the terminus of the 
State Railway was at Karibib, where it connected with the 
first section of the 3 ft. 6 in. gauge line to Windhuk and 
the south. During his retreat the enemy had removed the 
rolling stock and as far as possible destroyed both lines. 

To wait until the railway line could be repaired meant a 
long delay, and General Botha decided to advance with the 
mounted troops up the bed of the Swakop River. Before this 
advance could commence, supplies had to be collected as far 
forward as possible and all available transport was con- 
centrated on this work. Progress was necessarily slow, and 
as most of the water had to be brought from the coast for 
both men and animals the mounted troops were sent back 
to Swakopmund and the position was taken over by infantry. 
In the meantime the work of relaying the Otavi line as far as 
Usakos with a 3 ft. 6 in. gauge was pushed on. 



336 MEDICAL HISTORY OF THE WAR 

At dawn on the 26th April the railhead position at 
Trekkopjes was attacked by a strong force of the enemy. 
The attack failed, but covered by their artillery, the Germans 
were able to make good their retreat, leaving their dead and 
wounded on the field. The wounded were collected chiefly 
by " B " Section of No. 2 M.B.F.A. under Captains Edginton 
and Vaughan. 

By the end of April the mounted troops were ready to 
advance, and as a preliminary step a field hospital was opened 
at Salem. The route decided on presented endless difficulties, 
and the enemy had, wherever possible, placed contact mines 
in the track. Though the mines occasioned some casualties 
the mounted troops advanced rapidly. Otyimbingue was 
reached early in May and a field hospital was temporarily 
established by No. 9 M.B.F.A. Karibib then surrendered 
and the German forces retreated northwards in the direction 
of Omaruru. The advance had only occupied sixteen days, but 
until Karibib was taken both men and animals suffered severely 
from lack of water. 

With the fall of Karibib the mounted brigades closed in on 
Windhuk, and on the 12th May General Botha accepted its 
unconditional surrender from the Burgomaster. No. 9 
M.B.F.A. marched into Windhuk with the right wing of the 
force which had advanced up the Swakop Valley. After 
Windhuk had been reached the unit was subdivided into 
smaller sections which were allotted to smaller formations. 
The German military hospital at Windhuk, in which a number 
of sick and wounded had been left, was at once adapted for 
the needs of the Northern Force. At Karibib a hospital 
was also established in the best buildings available. 

At the request of the Imperial Governor of German South- 
West Africa a 48-hour armistice was arranged on the 20th May, 
but as the negotiations came to nothing the preparations 
for a northern campaign and an advance to Gibeon were con- 
tinued. On the 18th June the advance was simultaneously 
commenced by three separate columns. 

In the meantime the director of medical services, Colonel 
P. G. Stock, joined General Botha's staff at Karibib to arrange 
the reorganization of the medical services. During the 
advance from Swakopmund some of the mounted brigade 
field ambulances had not always been able to keep up over 
the rough tracks with the rapidly moving commandos. This 
was largely due to the fact that before the advance started 
the mules of their transport had been taken to drag forward 
supplies, and when they were returned to the ambulances just 
before the columns moved off the severe work had impaired 



OPERATIONS IN SOUTH-WEST AFRICA 337 

their condition. As the general staff anticipated heavy 
fighting, probably at Kalkveld, the question of increasing 
the mobility of the medical units was of the greatest importance. 
The personnel and equipment were, however, re-arranged and 
reduced as far as possible. With the reorganization of the lines 
of communication to Swakopmund, Major Whitehead, 
S.A.M.C., was appointed A.D.M.S., L. of C., with headquarters 
at Karibib. An ambulance train was organized to operate 
on the narrow gauge line to the north, and a field hospital 
was established at Omaruru. Subsequently Karibib became 
the clearing station for casualties on their way to Swakopmund. 

Most of the country traversed during the northern advance 
presented the same appearance for miles. Slightly undulating, 
it was thickly covered with bush, which though negotiable by 
mounted men to an extent that did not seriously retard 
movement, was thick enough to render anything but a 
restricted view impossible. Owing to the rapidity of the 
advance and the flanking columns continually threatening 
to cut his lines of communications, the enemy evacuated 
the position at Kalkveld without offering resistance. 

By the 24th June the railway from the south was open 
to Omaruru, and by the 2nd July to Kalkveld, which then 
became a large supply depot. Otjivarongo was taken by the 
end of June and a field hospital at once established there. 

The distance from Karibib to Otjivarongo is some 120 
miles, and from Omaruru onwards the facilities for watering 
men and animals existed only at two points. Nevertheless, 
the bulk of the force covered the distance in less than 
a week under most trying conditions of thirst. Otavi 
was then captured, and an unlimited supply of good running 
water the first seen during the campaign became available. 

The enemy now held a position of exceptional strength at 
Khorab. It was known that many mines had been laid and 
that the enemy was in force. Fighting with heavy casualties 
seemed imminent, and the field hospital at Omaruru was 
quickly transferred by motor lorries to Otavi. 

Dispositions were made for closing the exits from Khorab 
and the first infantry brigade was ordered to be ready to 
attack from the south. This brigade had marched the 270 
miles from Ebony Mine practically without a break. It covered 
the last 80 miles in four days, and the last 45 miles in 36 hours 
in order to be in time. No. 2 M.B.F.A. accompanied it and 
with short rations and little water covered the 245 miles over 
bad roads from Erongo in 16 days. Pourparlers were, how- 
ever, taking place, and shortly before the hour fixed for the 
attack a messenger arrived from the German Imperial 

(1735) Z 



338 MEDICAL HISTORY OF THE WAR 

Governor, Dr. Seitz, accepting the conditions offered, and at 
10 a.m. on July 9th the terms of surrender were signed. 

This terminated the campaign in the north and with it the 
operations of the Union Forces against the German troops in 
South- West Africa. 

During the advances up the Swakop Valley and from Karibib 
to the north the amount of sickness was fortunately small, 
but casualties had at times to be carried forward in the 
ambulance wagons. As opportunity offered they were sent 
back to the field hospitals at Salem and Otyimbingue. After 
the surrender of Windhuk the difficulties were too great to 
continue evacuating sick and wounded down the Swakop 
Valley, and the hospitals at Karibib and Windhuk were used 
for their reception until they could be moved to the coast by 
train. Karibib was the chief hospital centre on the lines 
of communication, but trains were soon running between 
Karibib and Windhuk 

The chief hospital base was always at Swakopmund, where 
No. 3 General Hospital was established in adequate buildings, 
the surgical division being in the San Antonius Hospital and 
the medical division in Prinzessin Ruprecht Heim. Later 
on the Prinzessin Ruprecht Heim was closed and the medical 
division transferred to the Swakopmund school, where altera- 
tions had been carried out and the buildings adapted for 
hospital purposes. Hot and cold water was laid on, sanitary 
accommodation provided, electric light installed, and the 
grounds fenced. 

After the railway was opened between Walfish Bay and 
Swakopmund the advisability of transferring the medical 
base to Walfish and erecting a hutted hospital near the landing 
stage was considered, but the proposal was not proceeded with 
as it was thought that the campaign would not last long 
enough to justify the work. 

From Swakopmund an ambulance train ran to the landing 
stage at Walfish Bay. The patients were transferred to 
lighters which were towed off to the hospital ship. From 
Walfish Bay to Cape Town is about 720 miles, and the voyage 
took from 3| to 5 days, the ship usually calling at Liideritz- 
bucht on the way down. At Liideritzbucht the patients had 
also to be transferred to the ship on lighters and it was always 
necessary to arrange for this being done before darkness set 
in. By the middle of August, 1915, the last of the patients 
had been evacuated to the Union of South Africa, and the 
military hospitals were either closed or reduced and adapted 
to the' needs of the small garrison left for the military occu- 
pation of the former German territory. 



CHAPTER XXI 

THE MEDICAL SERVICES DURING THE OPERATIONS IN SOUTH- 

WEST AFRICA (contd.} 

ORGANIZATION, AMBULANCE TRANSPORT, AND STORES 
HEALTH OF THE TROOPS 



scheme for the organization of the South African 
- Medical Corps was somewhat similar to that for the 
Territorial Force, R.A.M.C., in Great Britain. There was 
to be a small staff of whole-time medical officers and non- 
commissioned officers for administration and instructional 
duties, and a few non-commissioned officers, trained in 
medical duties, were to be posted to the medical section of 
the permanent force staff from the South African Mounted 
Rifles. The actual medical units were to be raised and trained 
under the terms of the Defence Act. In 10 of the 15 military 
districts, into which the Union was divided, assistant directors 
of medical services had been appointed. These officers were 
engaged in ordinary practice, but were to command the 
active citizen force sections of the South African Medical 
Corps when under training in their districts, and under the 
directions of Defence Headquarters were generally to assist 
in the military medical administration. When the war started 
some of the units were just going into training camps, others 
were called up for training and then mobilized, and others 
again raised or completed by volunteers. 

At Defence Headquarters the staff officer for medical services 
was directly responsible to the Minister for Defence and was the 
channel through which the Minister's instructions on medical 
administration would be communicated to those concerned. 
On the 1st September, 1914, when Colonel Stock was appointed 
Director of Medical Services, he assumed, subject to the 
Minister's instructions, responsibility for the medical services 
and the health of the troops. Medical headquarters were in 
Pretoria, but at the end of January, 1915, when the personnel 
had been recruited and the organization built up, they were 
moved to Cape Town, which became the chief medical base for 
the operations against German South-West Africa. 

One of the most pressing needs in the early stages was to 
increase the staff at headquarters, and Major Egerton Brown 
was appointed D.D.M.S. ; Lieut. -Colonel C. Porter, specialist 

339 

(1735) Z2 



340 MEDICAL HISTORY OF THE WAR 

sanitation officer ; Major M. W. McLoughlin, staff officer to 
the D.M.S. ; and Mrs. Creagh,* Matron-in-Chief. 

Throughout the campaign the medical headquarters staff, 
though augmented as the work increased, was maintained 
at a minimum. The work was carried on at high pressure, 
as owing to the rapidity of mobilization nearly every available 
medical officer with any military experience had immediately 
to be sent into the field. In the absence of any organization 
for the necessary medical care of the civilian population, it 
was impossible to provide at a moment's notice a sufficient 
number of medical officers from amongst the civil practitioners 
of the Union, even with the loyal co-operation of individual 
members of the medical profession, which was numerically 
weak in the Union, and was also depleted after the outbreak 
of hostilities by a number of its members proceeding to Europe 
for service with the R.A.M.C. 

An outbreak of pneumonic plague in Cape Colony during 
the early stages of the war, for which no definite cause could 
be assigned, and the prevalence of malaria in the Eastern 
Transvaal in the later stages, also added to the difficulties in 
the selection and appointment of medical officers. In spite 
of these difficulties, however, the profession made a splendid 
response to the call for volunteers, and 280 medical officers 
served for varying periods during the campaign. 

The decentralization, however, which under established 
conditions would have been the normal procedure, was 
rendered impossible by the lack of military experience and 
training of the personnel employed and involved almost the 
whole burden of control, organization, recruiting and instruc- 
tion being borne by the headquarters staff. 

Rules, regulations, orders, instructions, and memoranda on 
every conceivable subject of medical and allied interest had 
to be prepared and issued. Medical forms had to be drawn 
up or army forms adapted. Arrangements had to be made 
for the medical examination of recruits, which experience 
showed to be certainly one of the most difficult problems to 
deal with, and many mistakes were made. Indeed, it was not 
until later on in the war, when medical inspectors of recruits 
were appointed and medical examining boards established, 
that these difficulties could be adequately dealt with. 

The recruiting and training of subordinate personnel were 
rendered easier by the readiness with which men volunteered. 
A training camp under Lieut.-Col. G. H. Usmar, a former 
officer of the R.A.M.C., was established at Wynberg near 

Since Mrs. Stanford, R.R.C., O.B.E. 



OPERATIONS IN SOUTH-WEST AFRICA 341 

No. 1 General Hospital, but the period during which recruits, 
who were not trained with their units, could remain in it was 
never long enough. To compensate for the shortage of trained 
orderlies for nursing duties, additional nurses were employed, 
and many of these ladies cheerfully served in field hospitals 
under most trying conditions. 

A statistical section was organized under Mr. Pearce, of 
the South African Office of Census and Statistics, and a card 
system was introduced for admissions to hospital. Experience 
showed that this system was beset with difficulties which 
were only overcome by the hard work and perseverance of 
the sectional staff, but Mr. Pearce was subsequently able to 
draw up an amended scheme. 

Instructions were also issued in regard to the medical 
boarding of patients before discharge from base hospitals, and 
arrangements were made for handling and recording the pro- 
ceedings at medical headquarters. 

The fullest possible use was made of the civil hospitals 
in the Union both in connection with training and mobilization 
camps and also as centres in proximity to their homes to 
which patients could be evacuated from the medical bases. 
Every assistance was rendered by the authorities concerned 
and arrangements were completed under which practically 
every hospital in the Union would admit military patients at 
an inclusive daily fee of 5s. Much effective service was also 
rendered by local medical practitioners, who in most districts 
came loyally to the assistance of the military authorities. 

In the earlier stages of the campaign much important work 
was performed by the assistant directors of medical services 
in the military districts, but the greatest volume of this work 
devolved on Colonel Buist, the senior medical officer at Cape 
Town, and Lieut. -Colonel Temple Mursell and Major Horwich, 
the A.D.M.S. and D.A.D.M.S., Johannesburg, and their staff. 

Johannesburg was a large recruiting centre and the site of 
two mobilization camps and field hospitals. It also possessed 
the largest civil hospital in the Union, and numbers of serious 
surgical and medical cases were transferred to it. 

The organization of the field medical units, with the 
exception of transport and the allotment of medical officers 
to units, was similar to that laid down for the Imperial Forces, 
a mounted brigade field ambulance being the equivalent of 
the cavalry field ambulance of the regular army. 

As far as possible men with previous training were attached 
to regiments for water duties. A small percentage of the 
personnel of the five regiments of South African Mounted 
Rifles, which constituted a permanent force chiefly employed 



342 MEDICAL HISTORY OF THE WAR 

on police duties in normal times, was trained in medical duties, 
and this personnel with the addition of specially enlisted men 
formed the mounted brigade field ambulance which accom- 
panied Force A. As other units were formed every endeavour 
was made to post a small nucleus of trained men to each, 
and after Force A was broken up some of the personnel was 
used in this way. As far as possible one of the small staff of 
instructors or non-commissioned officers of the medical perma- 
nent force staff was posted to a medical unit as its warrant 
officer. Practically all these instructors had formerly been 
non-commissioned officers in the R.A.M.C. or had been 
seconded from it just before the war for temporary service 
with the Union Defence Forces, and their experience, ability 
and example were invaluable. Fortunately, also amongst 
the active citizen force units there was a number of non- 
commissioned officers who had served in the old volunteer 
medical corps of the Cape, Natal, and Transvaal, and it was 
largely due to them and the efforts of Colonel Odium that the 
various medical units became as efficient as they did. 

There being no depot for the S.A.M.C. as a corps, the head- 
quarters of No. 1 Field Ambulance at Johannesburg and the 
training centre at Wynberg were used as far as possible for 
this purpose, and many of the personnel recruited on the 
strength of these units were posted to other temporary forma- 
tions and units in the field. In this way the stationary and 
field hospitals on the lines of communication, which were 
sometimes started by the tent division of a field ambulance, 
were gradually built up. 

Medical units in the field obtained their reinforcements 
from the hospitals at the medical bases which were then some- 
times hard pressed for personnel. On these occasions the 
energy and enthusiasm of the hard-worked staff were most 
in evidence and carried them over many difficulties. 

The routes followed for the evacuation of casualties have 
already been indicated. With the exception of the Northern 
Force after its advance to Karibib, the A.D.M.S. with each 
force administered the medical services on the lines of com- 
munication to the base. 

Telegraphic communication with the various forces was 
quickly established by the South African Signalling Corps, and 
by arranging an appointment by telegram and for the services 
of a skilled telegraphist a conversation could be carried on 
by the D.M.S. from defence headquarters with an officer 
perhaps 1,200 miles away in the field. 

The lines of communication from Cape Town for medical ser- 
vices were supervised by the A.D.M.S. lines of communication, 




STRETCHER BEARERS, SOUTH AFRICAN MEDICAL CORPS. 



To face page 342. 



OPERATIONS IN SOUTH-WEST AFRICA 343 

with headquarters in Cape Town under the senior medical 
officer of the Cape Peninsula, Colonel Buist. When Major 
J. A. Mitchell vacated this appointment, he was succeeded by 
Lieut. -Colonel John Hewat, who afterwards became A.D.M.S. 
in the Cape Peninsula. 

The main base for the expeditionary force was at Cape 
Town, as already noted. Here the troops concentrated before 
embarking and camping sites had to be selected and prepared. 
During the rainy season the selection of suitable sites was 
difficult, and camps had to be formed on the slopes of Table 
Mountain. The selection of Cape Town as the base necessi- 
tated the immediate provision of hospital accommodation 
not only for the concentration of the troops, but also for 
the probable casualties coming back. The Imperial scheme 
for the defence of the Cape Peninsula provided for the 
mobilization of half a general hospital. As already stated, 
this was not immediately proceeded with, but the Imperial 
military hospital at Wynberg had been increased to 75 beds. 
When the Imperial garrison sailed this hospital was staffed 
by No. 1 Company of the S.A.M.C., and the hospital 
gradually expanded by utilizing the huts of Wynberg camp 
which gave accommodation for 850 patients. Lieut.-Colonel 
R. P. Mackenzie, the medical superintendent of the large civil 
hospital in Johannesburg, was appointed to command it, and 
with Major Merritt, a former officer of the R.A.M.C., as 
quartermaster, and some of the most experienced medical 
officers in the Union on the staff, No. 1 General Hospital 
quickly became a thoroughly efficient unit. When Lieut.- 
Colonel Mackenzie joined the Northern Force early in 1915, 
the command was taken over by Lieut.-Colonel A. B. Ward. 

Although no estimate could be made of the probable number 
of casualties, provision for further hospital accommodation 
was considered essential. The ground in the vicinity of No. 1 
General Hospital was suitable for its expansion by tents, but 
it was decided that, if possible, tented hospitals should be 
avoided during the heavy rains of the Cape winter. In 
addition separate accommodation had to be provided in all 
hospitals for coloured and native patients. A certain number 
of beds was reserved in the New Somerset and other hospitals 
in the Cape, but fortunately at Maitland, one of the suburbs 
of Cape Town, the erection of a large civil hospital for 1,000 
chronic sick was nearing completion. Sir Frederick de Waal 
readily agreed to place these buildings and their equipment 
at the disposal of the Department of Defence, and in February, 
1915, they were opened as No. 2 General Hospital under the 
command of Lieut.-Colonel Thornton. 



344 MEDICAL HISTORY OF THE WAR 

Patients from Walfish Bay, Liideritzbucht, and Port Nolloth 
were transferred by ambulance transport or hospital ship 
to Cape Town and admitted into one of the hospitals in 
the Cape Peninsula. Only in exceptional cases were patients 
from Upington transferred by train to De Aar and Cape Town. 
The hospitals at Kimberley and Johannesburg were more 
convenient for them, and the accommodation in the hospitals 
in the Cape was kept as free as possible for eventual casualties. 
Little use could be made of the hospital at Tempe near Bloem- 
fontein for cases from the campaign in South- West Africa. 

No scheme had been prepared for dental service, a want 
which was quickly felt, as it was in other theatres of war. 
Invaluable services were, however, rendered in the most 
public-spirited manner by dental practitioners at Cape Town, 
Johannesburg, and other centres throughout the Union, and 
dental units were organized both for the Central and Northern 
Force. 

A provisional scheme for a South African Military Nursing 
Service had been prepared prior to the war, but further action 
had been postponed. With the outbreak of hostilities and 
the organization of military hospitals it became imperative 
to provide an adequate number of trained nurses, and pro- 
visional orders and instructions were brought into force. A 
matron-in-chief was appointed, who was responsible to the 
D.M.S., and a nursing service was rapidly organized. When 
called up for service the organization and duties of the 
S.A.M.N.S. were similar to those of the Imperial Nursing 
Service, but a larger proportion of nurses was enrolled in 
order to compensate for the shortage of nursing orderlies. 
Only trained nurses were accepted, but there was no lack of 
volunteers, and during the campaign 174 ladies were enrolled 
who rendered invaluable service not only in the general and 
stationary hospitals, but also in many cases in the field 
hospitals which were established with the various columns. 
On the termination of the campaign the majority of them 
volunteered for service in other theatres of war. 

The scheme for sanitation which had been approved before 
the war was similar to that of the Imperial Army. Few 
combatant officers, however, had received instruction in field 
sanitation, and the special sanitation officers had to contend 
with many difficulties, particularly in connection with some 
of the newly raised mounted units. Even when camps were pre- 
pared for their reception, the men would use the latrine seats 
for firewood and the water pipes as tethering places for their 
horses. A small copiously illustrated handbook on field 
sanitation was hurriedly prepared and issued in English and 



OPERATIONS IN SOUTH-WEST AFRICA 345 

Dutch. As many trained sanitary inspectors as possible 
were posted to the sanitary sections which were gradually 
organized and which did invaluable work. 

The difficulties were probably greatest with the Northern 
Force. When the mounted troops were concentrated round 
Swakopmund there was a shortage of materials and transport, 
and it was only by the perseverance of Major Maynard and the 
personnel working under his directions that any headway was 
made. To meet the difficulties, natives were largely engaged 
for sanitary duties, and were employed with each unit under 
a regimental non-commissioned officer, who received extra 
pay at the rate of 2s. 6^. a day. 

The chlorination of drinking water was insisted on. No 
water-carts of a modern type were available, and even when 
water was brought up in bulk from Cape Town the possibilities 
of contamination were many. At first chloride of lime 
was issued in sealed tubes, each tube containing sufficient for 
one cartload of water. Later, when the supply of tubes was 
exhausted, the chloride of lime was issued in tins and a glass 
measure supplied. 

Judging by the experience of previous campaigns it was 
anticipated that the sick-rate, more particularly from enteric 
fever and dysentery, would be high, and every effort was made 
to organize and carry out measures to protect the troops. 
Memoranda on dysentery, typhoid fever, and anti-typhoid 
inoculation were drawn up and issued. 

From the beginning the importance of the para-typhoid 
fevers was recognized, and in the arrangements made for 
inoculating the troops a mixed vaccine of typhoid and para- 
typhoid strains was used. The greater portion of the vaccine 
was prepared under the direction of Dr. Watkins Pitchford 
in the South African Institute for Medical Research, but over 
33,000 doses were generously supplied by Dr. Pratt 
Johnson from the South African Clinical Research Laboratory, 
Johannesburg. At first there was some hesitation amongst 
the men to submit themselves to inoculation, but after it had 
been intimated that only men so protected would be taken 
to South- West Africa, and the first batch of 3,000 had been 
inoculated under Major Maynard's direction in one afternoon, 
there was no further difficulty. 

It is estimated that at least 95 per cent. probably more 
of the troops were adequately inoculated, but under the con- 
ditions which arose it was unfortunately impossible to com- 
plete the records from the regimental rolls. Owing to the 
protection afforded few cases of typhoid occurred. These 
it was possible at once to deal with effectively, and directly 



346 MEDICAL HISTORY OF THE WAR 

they were able to travel they were transferred to the Union 
and not again sent into the field. 

Flies, at all times in evidence in South Africa, were the 
common agencies for the spread of intestinal diseases. A 
highly efficient and economical method for dealing with these 
pests was recommended by Mr. Malley, one of the Government 
entomologists. Briefly, it consisted in the use of a " poison 
bait," made by sweetening and colouring a solution of arsenite 
of soda. An effective method for distributing the bait in 
likely places was to hang up branches with smooth leaves 
which were periodically sprayed with the arsenical solution. 
The method proved so successful in the Cape Peninsula under 
Mr. Malley's direction that large supplies of arsenite of soda 
were obtained and issued for use with the different forces. 

Under Major Haydon, the sanitation officer with the Central 
Force, the methods originally recommended were considerably 
modified. Using Cooper's Dip, a large supply of which was 
found ready to hand, and which possessed the further 
advantage of being already coloured and more or less familiar 
as a poison, the distribution was supervised by the medical 
officers of the various units under whom a special sanitation 
non-commissioned officer usually took charge of the arsenical 
supplies. Collections of manure which could not be buried 
were regularly sprayed. Deep trench latrines were dug and 
the contents sprayed, -and in some cases when water was 
very scarce the contents of the urine buckets proved an 
effective liquid for dissolving the arsenical preparation. By 
the adoption of the arsenical solution combined with other 
methods of camp sanitation Major Haydon reported that the 
mounted regiments of the Central Force practically cleared 
their camps of flies in a fortnight, 

Reference has been made to the poisoning of water supplies 
by the enemy. A few days before the first force embarked 
the Intelligence Staff reported that the Germans might resort 
to this device. The director of medical services at once 
appealed to Dr. McCrae, the Government analytical chemist, 
for assistance, and in less than forty-eight hours a series of 
field outfits for testing for poisons had been prepared. Instruc- 
tions were drawn up for their use and the outfits were 
despatched by train to the force at Cape Town.* Several 
chemists were subsequently attached to the sanitation section 
of the S.A.M.C. and posted to the various columns. The poison 
most commonly used was some preparation of arsenic. Protests 
to the commander of the German forces were unavailing. 

* A summary of the directions for the use of the field poison testing 
equipment afterwards issued to all columns is given in Appendix G. 




WARD IN "TROVATO" CONVALESCENT HOME. 



To face page 347 



OPERATIONS IN SOUTH-WEST AFRICA 347 

After the capture of Windhuk General Botha in a proclama- 
tion referred to this flagrant breach of the Hague Con- 
vention and reserved to himself the right at any time to exact 
reprisals. 

Much of the laboratory work was done at the Government 
Laboratory in Cape Town by Major Robertson who worked 
shorthanded the whole time. Laboratories were afterwards 
organized with the Central and Northern Forces, and every 
use was made of the extensively equipped German Government 
institutions which were taken over as the Union troops 
advanced. 

On the whole the troops suffered very little from animal 
parasites. On the first complaint of lice from one of the 
mobilization camps the whole question was promptly taken 
up by the specialist sanitation officer, and a memorandum on 
the subject was drawn up and circulated. Many factors no 
doubt contributed to this comparative freedom, and conditions 
such as existed in France never arose. 

The clothing issued was on the whole satisfactory, but the 
great extremes of temperature frequently experienced were 
most trying. At one time there were considerable difficulties 
in obtaining serviceable boots. 

More especially with the Central Force round Liideritzbucht, 
the glare from the white sand was a constant source of dis- 
comfort, in some cases causing acute conjunctivitis. Tinted 
goggles were in consequence issued to the troops after 
the initial difficulties in obtaining a sufficient supply had been 
overcome. As the use of veils as a protection against the 
fine driving sand had been suggested, a large number was 
made by voluntary workers in Cape Town and issued. Under 
certain conditions they afforded some protection and added 
to the comfort of the troops. 

The scale of rations approximated to that in force in France, 
6 oz. of mealie meal with an ounce of sugar being a sub- 
stitute lor Ib. of fresh meat at the option of commanding 
officers. Transport difficulties often made the issue of the 
full ration impossible, but the contracts were carefully super- 
vised and the rations issued were of good quality. 

The special supplies for the hospitals with the Northern 
Force were at first hardly sufficient, but the shortage of fresh 
milk was only met, arid that to a limited extent, by sending 
up a number of cows from Cape Town. 

Provision had been made in the Union Defence Act for 
voluntary aid being employed in connection with the medical 
services. From its inception, however, the Department of 
Defence had had more urgent duties to carry out, and the 




MEDICAL HISTORY OF THE WAR 

co-ordination of voluntary aid in time of war had not been 
dealt with. 

When hostilities commenced there were branches of the 
St. John Ambulance Brigade in South Africa, chiefly in con- 
nextion with the De Beer Mines and the South African railways. 
These detachments proved a valuable recruiting ground for 
the S.A.M.C. and, at Cape Town, St. John Ambulance 
details under the direction of Captain R. Macintosh rendered 
consistently valuable service in connection with the disem- 
barkation of invalids and on the ambulance trains from the 
docks to the stations at Wynberg and Maitland. To assist 
in conveying the casualties from these stations to the hospitals 
a regular convoy of private motor cars was arranged by 
Mr. Henessey, of the Automobile vlub. 

Shortly before the war a Red Cross Society had been formed 
in the Transvaal, though its activities at that time were 
chiefly confined to mining work. In addition the Good Hope 
Red Cross Society, dormant since the South African War, 
existed in Cape Town, and Red Cross societies were afterwards 
organized in Natal and the Orange Free State. 

From the outbreak of war these bodies rendered valuable 
service. Innumerable quantities of comforts were supplied to 
the hospitals, and the generous response to the public appeal 
placed sufficient funds at their disposal to continue a work which 
contributed materially to the comfort of the sick and wounded. 

With the almost overwhelming pressure of work at Defence 
Headquarters it was impossible to undertake the organization 
of the numerous offers of assistance or deal with the offers 
of private residences as hospitals, and on the advice of the 
director of medical services the Minister of Defence appointed 
a committee under the chairmanship of Sir Thomas Smartt 
to deal with the whole question. This committee, which con- 
sisted of some of the most prominent citizens, was known 
as the official advisory committee on voluntary aid and met 
at Cape Town. One of the primary objects of the com- 
mittee was to co-ordinate all offers of voluntary assistance, 
but it was not until the end of the campaign in South- West 
Africa that the various voluntary aid organizations were co- 
ordinated, with joint secretaries, for the duration of the war. 
Starting with a donation of 30,000 from the Transvaal 
Chamber of Mines, further funds were soon raised, and the 
committee undertook the provision of convalescent homes. 
The " Trovato " Convalescent Home was opened near No. 1 
General Hospital, and, soon after, an additional home was 
opened in Mr. J. W. Jagger's house on the sea front at 
St James's. 




DINING ROOM IN "TROVATO" CONVALESCENT HOME. 



To face page 348. 




GERMAN CAMEL AMBULANCE. 




LIGHT AMBULANCE WAGONS. 



To face page 349- 



OPERATIONS IN SOUTH-WEST AFRICA 349 

In addition to the convalescent homes. Sir Thomas Smartt's 
committee provided the funds and undertook the alterations 
and fitting out of the " Ebani " as a hospital ship in accordance 
with the general specifications prepared by the director of 
medical services. The equipment and fittings of the " Ebani " 
were subsequently presented to the Imperial Government 
when it took over the " Ebani " on the termination of the 
South-West African campaign. Sir Thomas Smartt's com- 
mittee also supplied the necessary funds with which to 
purchase the full equipment for No. 1 South African General 
Hospital when it proceeded to Europe. 

The supply of veils to the troops by voluntary aid has 
already been referred to. It was entirely a matter of voluntary 
effort directed by a committee of ladies in Cape Town. 

With regard to ambulance transport and methods of 
evacuation, no reserve of stretchers existed in the Union, and 
large numbers had to be made locally for the ordnance 
department. Unfortunately they were not always strictly in 
accordance with the standard pattern, and when not inter- 
changeable occasioned many difficulties. The type of ambulance 
wagon was under investigation when the war commenced. The 
heavy army ambulance wagon was considered unsuitable, 
and a modified light ambulance wagon was adopted. This 
pattern was then built in the Union and issued to the field 
ambulances. As animal-drawn transport it proved satis- 
factory. A very light form of " galloping " ambulance wagon 
was also designed, and though most useful on occasions was 
found to be of limited utility. Round Liideritzbucht the use 
of wheeled vehicles was impossible and sleighs with runners, 
12 to 18 in. wide, were the best transport devised for 
getting over the sandy wastes. Many varieties of wheeled 
carriages for stretchers were also supplied at various 
bases, but their use was never popular with stretcher 
bearers. 

Motor ambulance cars were first introduced in connection 
with the hospitals in the Union, and were preferable to other 
forms of transport. Two were issued to each of the mounted 
brigade field ambulances in place of animal-drawn ambulance 
wagons, and were found invaluable. Had it been possible 
animal transport would have been replaced to a much greater 
extent by motor ambulance cars. The type eventually 
designed consisted of a light car, with a relatively high engine 
power, to carry two lying-down cases and three sitting. For 
desert work the Germans had a camel corps and used the 
form of transport shown in the photograph, but for various 
reasons this was not adopted by the S.A.M.C. 



350 MEDICAL HISTORY OF THE WAR 

The only rail ambulance transport available in the Union, 
beyond ordinary carriages, consisted of two coaches of the 
Princess Christian Hospital train which had been employed 
during the South African War. These were added to by 
building additional coaches of similar design. The South 
African Railways also converted empty postal vans, which 
with supports for stretchers, wide doors and suitable fittings 
made satisfactory accommodation for lying - down cases. 
Zavodoski's method for slinging stretchers in empty vans 
was utilized by Lieut. -Colonel de Kock at Bloemfontein for 
the purpose of organizing an ambulance train quickly, and 
for local use it proved efficient. To deal with individual cases 
a few motor rail trolleys were prepared and sent to the 
Northern and Central Forces, but their use was limited. 

For sea transport hospital accommodation was first prepared 
on the " City of Athens," which was used as an ambulance 
transport. In the meantime every endeavour was being 
made to obtain a vessel for hospital purposes only, and 
eventually the s.s. " Ebani " was selected by the Senior Naval 
Transport Officer, Captain R. C. K. Lambert, R.N., and by 
Colonel Stock. As soon as the " Ebani " had been fitted 
and equipped as a hospital ship in Cape Town a staff was 
selected, the belligerent Governments were notified, and 
Lieut. -Colonel D. MacAulay took over the duties of officer 
commanding. As the " Ebani " had been a cargo vessel for 
the West African trade, the decks were not unduly divided, 
and large airy wards with single-tier swing cots were prepared. 
In addition to the fitted accommodation a reserve of naval 
swing cots was carried. In an emergency the " Ebani " 
could have carried about 500 patients inclusive of coloured 
and native cases, for whom separate accommodation was 
provided. 

When war broke out the South African forces possessed 
practically no medical equipment. A quantity of field medical 
equipment was on order in England, but on the outbreak of 
hostilities in Europe this was taken over by the Imperial 
Government. The only field equipment which could then 
be obtained was a certain amount of obsolete pattern left 
by the Imperial garrison. This, however, was not sufficient, 
but with the aid of the Union Department of Prisons and 
the Ordnance Department of the Union Defence Force field 
medical panniers were made and fitted. On the whole these 
answered well, but breakage of containers was heavy, as 
suitable bottles were unobtainable and the ordinary pattern 
medicine bottle had to be used. The wholesale druggists 
also rendered every assistance, and the Public Health 







TYPE O" MOTOR AMBULANCE CAR USED DURING 
SOUTH-WEST AFRICAN CAMPAIGN. 



To face page 351. 



OPERATIONS IN SOUTH-WEST AFRICA 351 

Department was able to supply quinine in sufficient quantities 
for the Northern advance. 

At the commencement of the campaign Major Cope was 
placed in charge of the section of medical headquarters dealing 
with medical equipment and proceeded to Cape Town to 
organize base medical stores and generally supervise the 
equipment of units before their departure. Later, advance 
depots were opened at Liideritzbucht, Swakopmund, Upington 
and, prior to the Northern advance, at Karibib. A smaller 
depot was also opened for a short time at Kimberley to supply 
the requirements of the Eastern Force. 

Considerable difficulties were met with in obtaining the 
requisite X-ray plant. Fortunately X-ray equipment was 
never required to any great extent in the field. Fairly satis- 
factory installations were found in some of the hospitals taken 
over from the enemy, but a train with an X-ray equipment, 
which was captured near Riet, was unfortunately destroyed. 

No material shortage of necessary drugs occurred, but 
at times it was not always possible to complete the requisitions 
of medical officers, who often objected to substitutes. Few 
appeared to appreciate the difficulties under which supplies 
were obtained and sent forward. The old pattern equipment 
was also sometimes a source of complaint, and one which 
would certainly have been justified if it had been possible 
to obtain more modern equipment from Europe. As the 
campaign progressed, quantities of German stores were 
obtained which proved extremely useful to the units in the field. 

On the termination of the campaign medical stores were 
gradually returned to the base medical stores at Cape Town, 
and steps were taken to sort out such as were still of use and 
refit medical panniers for further service in case of need. 

With regard to the health of the troops, the following 
statistics refer to a period of 375 days, namely, from 5th 
August, 1914 the outbreak of war to 14th August, 1915 the 
date of the evacuation of the last sick details from South- 
West Africa to the Union. It must be noted, however, 
that it was only in September, 1914, that the South African 
Parliament sanctioned the campaign, and that the terms of 
surrender which terminated the operations of the Union 
Forces against the Germans in South-West Africa were signed 
on 9th July, 1915. 

On the other hand, when war was declared a number of 
training camps were open in the Union, and these formed 
a basis on which the mobilization was built up until definite 
centres were established. No record offices or statistical 
branch then existed and, as these had to be organized as the 



352 MEDICAL HISTORY OF THE WAR 



mobilization proceeded, it was impossible to determine in 
many instances whether the earlier admissions to hospital 
had been definitely placed on an active service footing or not. 

There were great difficulties in arriving at the average daily 
strength. The records show that 76,467 Europeans were 
enrolled, but the designation of units was sometimes changed, 
and it was not until the beginning of 1915 that a complete 
field state was compiled. However, after investigating all 
sources of information the mean daily average strength of 
the white troops for the whole period of hostilities can be 
taken as approximately 33,000. 

Difficulties also occurred in regard to medical statistics, but, 
as at the beginning a card system was introduced for 
admission to hospitals and a careful continuous check and 
revision were carried out at the time, it is considered that errors 
in the following figures have been reduced to a negligible 
quantity : 

Admissions to Hospital : 

The total number of admissions to hospital for all causes 

was 25,367 

Remaining in Hospital : 

At the close of the campaign, of the 25,367 admissions, 

the number remaining in hospital was . . . . 578 

Sick-rates : 

The average sick-rate per 1,000 during the period 

1st January to 14th August, 1915, was .. .. 3'16 

The average number constantly sick, officers, N.C.O.'s 

and men, was .. .. .. .. .. .. l,126 - 5 

The average sick time to each soldier was . . . . 12-8 days 

The average duration of each case of sickness was . . . . 16-65 days 

Deaths : 

Killed in action or died of wounds .. .. .. 122 

Killed in action or died of wounds in operations outside 

German South- West Africa . . . . . . . . 131 

Died of accident or misadventure . . . . . . . . 58 

Died of disease .. .. .. .. .. .. 115 

The total number of deaths from all causes was conse- 
quently . . . . . . . . . . . . . . 426 

The death-rate from disease per 1,000 per annum was . . 3-39 

The chart shows the total number of cases remaining in 
hospital each week, the strength of the force, and the weekly 
sick-rates. 

The number of admissions to hospital, deaths from disease, 
and the average duration of treatment for each group of 
diseases are shown in Appendix G, Table I. In Table II of 
the same appendix some of the more important diseases 
affecting military operations are shown in detail. 

Two hundred and fifteen cases of typhoid or enteric fever 
were admitted to hospital. In addition, 15 probable cases, 
not treated in military hospitals, were traced, bringing the 
total number up to 230. Of the total cases only 69 occurred 



VTIENTS IN HOSPITAL, AVERAGE STRENGTH 



SICK BY WEEKS DURING THE 



AFRICAN CAMPAIGN. 



1315 



r MARCH 



7 6 



APRIL 



MAY 



JUNE 



21 91 6 



31 0| 71 4131 



JULV 



AUQ?T 



v- 



APPROXIMATE 

STRENGTH 

5QOOO 



45000 



40,000 



35,000 



' 



che 
urred 



INCIDENCE OF ENTERIC FEVER 
DEATH RATIOS PER 1.000 AVERAGE STRENGTH 



A. FOR WHOLE PERIOD - B. PER 
SOUTH AFRICAN WAR GERMAMHERRERQ CAMPAIGN 

1898 -1902 1904-7 



ANNUM 



SOUTH WEST AT RiC A 



1314 -15 




A. 



B. 



0-78 



IQ3I4 



075 



MaJbyASon.Uk. 



OPERATIONS IN SOUTH-WEST AFRICA 353 

in the area of hostilities. Of the remainder, 48 occurred at 
the Training Depot of the South African Mounted Rifles at 
Pretoria, the infection being traced to a native " carrier " 
employed in the cookhouse. This outbreak had no connection 
with the campaign, but the figures were included in the hospital 
returns. There were 20 deaths amongst the cases treated in 
military hospitals, giving a case mortality of 9'3 per cent. 
Amongst the outside cases six deaths occurred, bringing the 
total deaths from typhoid and paratyphoid fevers up to 26 
equivalent to O78 per 1,000 of average strength for the whole 
period. The annual mortality ratio per 1,000 was 0'75. It 
is instructive to compare these figures with those of two recent 
campaigns in Africa, namely, the South African War of 1899- 
1902, and the German campaign against the Herreros of 1904- 
1907. The comparison is shown in the following table : 







Total 


Ratio per 1,000 of 






Deaths 


Average Strength. 


Campaign. 


Average 
Strength. 


from 
Enteric 




For the 








Fever. 


whole 


Per 








Period. 


Annum. 


South African War, 1899-1902 . . 


209,404 


8,227 


38-8 


14-7 


German Herrero, 1904-07 


11,367 


529 


46-5 


16-3 


South-Wcst African, 1914-15 


33,000 


26 


0-78 


0-75 



In the German Herrero campaign the proportion of inocu- 
lated troops was stated to be very high, but the vaccine used 
was not prepared according to the methods so successfully 
used in the war of 1914-18. 

The comparison is still further shown in the diagram, 
and is perhaps all the more striking when it is remembered 
that the figures for the first two campaigns refer to well- 
I organized regular troops. 

Some 500 cases of malaria were admitted to hospital, but 
I in the majority of cases the disease was not contracted in 
South-West Africa. North of a line drawn east and west 
Ithrough Gibeon malaria was stated to be endemic and special 
lanxiety was felt in regard to the advance north of Omaruru. 
[Preparations were made and instructions issued for the 
wophylactic use of quinine, but the fact that the troops did 
lot suffer was probably chiefly due to the advance being made 
in the winter months. 

With regard to dysentery, figures showing the incidence of 
the disease in the different .forces are unfortunately not 

(1735) AA 



354 MEDICAL HISTORY OF THE WAR 

available. It is known, however, that the majority of the 
cases, as well as a number of cases of enteritis, occurred in 
the Northern Force at Swakopmund. A suspicion that the 
wells had been contaminated was never confirmed, though 
tubes containing a mixed culture of a streptococcus and a 
dysentery bacillus were found in the water supply at Riet. 
Similar cultures in bulk were afterwards discovered in the 
German State Bacteriological Laboratory at Windhuk. As 
will be seen from Table II of Appendix G, the disease was of 
a very mild type, the case mortality being only 1-5 per cent., 
and the average duration of stay in hospital 15-52 days. 

There were 227 admissions for syphilis and 1,130 for 
gonorrhoea, a proportion of 1 to 5. The incidence ratio 
per 1,000 per annum on the average strength was 6- 1 for syphilis 
and 33-2 for gonorrhoea. The average duration of treatment 
in hospital was 37-12 days for syphilis and 21-67 for gonorrhoea, 
but stringent orders had been issued that every soldier who 
contracted venereal disease was to be discharged from the 
service and not permitted to take any further part in the 
campaign, so that the actual duration of each disease is 
uncertain. 

Only 124 cases of pneumonia, with a case mortality of 8 per 
cent, were admitted to hospital. The reasons for the low 
incidence are not entirely clear, but it is probably accounted 
for by the fine stamina of the troops and the absence of any 
virulent infection. The open-air life, which the troops led, 
may have accounted for this. 

Bilharzia is endemic in many parts of the Union of South 
Africa, and the 153 admissions for this disease cannot be 
taken as any index of the number of men affected. On the 
other hand, an average stay in hospital of just over 15 days is 
an indication of the importance with which the disease was 
regarded on active service. 

Admissions to hospital include 406 cases of heat-stroke or 
other effects of heat, with only one death. The majority of 
cases occurred amongst troops operating in the vicinity of 
Upington during January, February, and March, 1915. The 
predominant symptoms were a few days' fever, severe headache, 
and general pains, followed by prostration. Upington, which 
lies in the valley of the Orange River, is extremely hot during 
this period of the year, but it seemed doubtful whether the 
diagnosis was correct. Enquiries were instituted and it was 
then established that the cases bore a close resemblance to 
phlebotomus fever. No previous account of sand-fly fever 
having occurred in South Africa could be traced, and oppor- 
tunities did not occur for an extended search for the sand-fly. 



OPERATIONS IN SOUTH-WEST AFRICA 



355 



The opinion, however, was formed that the majority of the 
cases were cases of phlebotomus fever.* 

The amount of dental deficiency was considerable and 
many men were no doubt accepted whose teeth rendered them 
unsuited for active service in the field. The task of rendering 
them dentally fit in the time allowed would have been 
impossible. 

In connection with gunshot wounds, it is of interest to note 
that gas gangrene and tetanus were unknown. Suppuration 
followed in many cases, but wounds on the whole did well under 
the ordinary methods of treatment. 

The weekly sick-rates for the period 27th December, 1914, 
to 14th August, 1915, are shown in the chart and in Table III 
of Appendix G. The causes of death from diseases are shown 
in Table IV of Appendix G. 

The number of admissions to, and the number of deaths in 
hospitals classified according to the arm of the service are 
shown in Table V, and a summary of the numbers of officers, 
non-commissioned officers and men treated at the principal 
hospital bases is given in Table VI of the same Appendix. 

A large number of natives accompanied the forces to South- 
West Africa. Most officers had their own native batmen, 
and natives were largely employed in connection with hospitals, 
with regimental transport and for sanitation work. Exclusive 
of such natives the numbers recruited for work on the railways, 
for transport and remount duties, and as general labourers 
are shown in the following table, which gives the number of 
native labourers recruited territorially for service with the 
Union Defence Forces during the period 4th August, 1914, to 
31st August, 1915 : 



Nature of 
Employment. 


Cape. 


Trans- 
vaal. 


Orange 
Free 
State. 


Basuto- 
land. 


Bechu- 
analand 


Natal. 


Total. 


Union Railways . . 
S.W.A. Railways. . 
Transport and 
Remounts 


3,873 
2.757 
7,392 


1,768 
4,651 
3,818 


61 
922 
753 


56 
2 


305 
686 
303 


122 


6,063 
9,018 
12,378 


General Labourers 
Total 


1,808 


3,593 


340 





32 


314 


6,087 


15,830 


13,830 


2,076 


58 


1,326 


426 


33,546f 



The estimated daily average number employed was 15,000. 

* A paper by Captain Cairns, S.A.M.C., on the cases at Upington, appeared 
in the South African Medical Record for March, 1916. 

f These figures are exclusive of a number of natives engaged indepen- 
dently and taken to German South-West Africa by units or individuals. 

(1735) AA 2 



356 MEDICAL HISTORY OF THE WAR 

Whilst natives with units were looked after by the medical 
officer attached to the unit, the responsibility for the medical 
care of others was also thrown on the South African Medical 
Corps and separate accommodation had to be provided for 
them in the hospitals. 

Before proceeding to South-West Africa natives were as 
far as possible inoculated against typhoid fever, but complete 
records are not available either with regard to the exact number 
inoculated or the general incidence of disease. The amount of 
sickness was small, but the number of deaths, 104, cannot be 
taken as exhaustive or complete.* They merely indicate the 
general health of the native labourers. No serious outbreak 
of disease, however, occurred, and there were very few cases 
of enteric fever or dysentery amongst them. 



* See Appendix G, Table VII. 



APPENDIX A 

MEDICAL UNITS OF THE EXPEDITIONARY FORCE 
MOBILIZED IN AUGUST, 1914 



357 



358 



MEDICAL HISTORY OF THE WAR 



1 


d d 

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j III III iii ill fii ill ii 

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fill 


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6*0 












*, 






88 


a 
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Commanding Officer. 


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..8888 

c a a a 


i 


Name of Unit 


Cavalry Divisioi 
valry Field Ambula 
valry Field Ambula 
ivalry Field Ambula 
valry Field Ambula 


ll -2 s 1 s 1 8 
ZJ |888 -?888 f888 -888 f 888 1 888 (1:88 

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-" 


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0000 


d d o' d odd odd odd d d d odd do 
Z ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZ 



! 



APPENDIX A 



359 



I 

<s 





i 
1 




I 
1 
i 
I 
















cd i 
i 


1 
I 


I 


I 


G 
1 
i 


c 

1 


a 
1 


q 

I 








g 


5 











3 


I 


a 


i 


ft 

a 

a 

-3 


I 
1 
2 


t, 

8 

a 


1 

n 


A 

I 


1 
a 


1 


i 

B 

a 




(8 


| 


1 


1 


1 


1 


4) 


5 

a 
















a 


.U 


v 


3 


m 


o> 


o> 


o> 


8 






a 
m 


00 


r/> 


00 


00 


GO 


00 








oo 


t^ 


t~- 


[^ 


t^ 


00 






















c 


'i 

















?-- 


3 c 


3 


CT> 


CT) 


0. 


0> 


3 


Q 


f= 




22. 
o 


5. 


5- 


92. 


CO" 


1 




o 


3 
















Place of 


>, 

3 
| 

j 


Portsmouth 


Maidstone . . 


Aldershot 


Aldershot 


M 


Portsmouth 








































J 


ej 
c 


\ 


c 

(j 


i 


Major F. A. Symons . . 


1 



*2 

t 

| 


Major K. B. Barnett . . 


Major J. G. McN aught. . 




n 

3 

Is 


V 

(2 

m 

"o 
o 

3 
















'' 
























"i 

"c 

a 

n 
2 




No. 1 Clearing Hospital 


No. 2 Clearing Hospital 


No. 3 Clearing Hospital 


No. 4 Clearing Hospital 


No. 5 Clearing Hospital 


No. 6 Clearing Hospital 



360 



MEDICAL HISTORY OF THE WAR 



c 

3 

*^? cd 
Ojad 

* i2 

u (4 

OJ3 

PH g 


t 


eJ 

1 


g 


2 


s 

&0 







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1 


6 


4) 





6 




-2 

5 


rt 

M 


3 
O 
ffl 


1 

B 


rt 

W 


3 



rt 

W 


3 
o 




ffi 


1 


rt 
W 


rt 
W 


rt 




























and Port of 
barkation. 

Port. 


Dublin . . 


Southampton 


Dublin . . 


Southampton 


Southampton 


Southampton 


Southampton 


g 

->-> 

3 
O 

cn 


Southampton 


Southampton 


Southampton 


Southampton 


Iw 
















t 


^f 


"* 


-f 


rr 


Q 6 


O5 


05 


05 


05 


O5 


O5 


O5 


O5 


05 


O5 


05 


05 


& 


00 


00 


00 


a 


00 


00 


00 


00 


00 


00 


00 


00 




00 


CO 


00 


CD 
CN 


Tf 


CD 


^< 


CD 


<* 


2 


CD 


CD 
C<1 


rt 


* 


* 


* 












<* 


* 


^ 


* 




05 


05 


O5 


05 


O5 


O5 


O5 


O5 


O5 


05 


O5 


O5 


^'0*0.0 


00 


CO 


00 


00 


00 


00 


00 


00 


00 


00 


00 


00 


Q 3~ 


U5 


00 


CN 


1/5 


^ 


tN 


o 


% 


O5 


00 


CD 
CN 


in 






















































Place of 
Assembly. 


Dublin . . 


Tidworth 


Dublin . . 


Woolwich 


Portsmouth 


Woolwich 


Aldershot 


Woolwich 


Colchester 


Burscough 


Devonport 


Chatham 




























Commanding Officer. 


Bt.-Colonel F. Smith 


1 

.s 


a 
O 

C/3 

"w 

| 

3 


Lieut.-Colonel A. L. F. Bate 


Major W. J. Taylor 


Major H. Hewetson 


Lieut.-Colonel W. E. Berryman . 


Lieut.-Colonel C. A. Young 


1 

V 

^2 
W 

f 


Major E. A. Bourke 


Major J. R. McMunn 


1 

1 
<J 

ffi 

l-l 

O 

3" 

s 




























4* 

'3 


*"* 


CN 


CD 


< 


U5 


CD 


^ 


X 


05 


o 


~ 


CN 


M 


o 


O 




fc 







o 
55 


O 

55 


o 
fc 


o 
55 


O 


| 


o 


O 

55 



APPENDIX A 



361 



Port of 
Disembarkation. 














Boulogne. 
















Havre. 


Havre. 


Rouen 


Rouen 


Rouen 


2 

n] 

s 


0) 

I 

a 


? 

(4 

a 


<u 
M 



a 


Rouen 


Rouen 


Havre 


and Port of 
barkation. 

Port. 






























Dublin . . 





a 




C 



e 
o 


c 
o 








a 
o 


d 




a 




c 
o 


a 
o 


Southamp 


Southampi 


Southamp 


Southampi 


Southamp 


Southampi 


Southamp 


Southampi 


Southamp 


Southampi 


Southamp 


Southampi 


5 a 

rtW 

Q 6 
*-> 
a 

P 


-<f 


** 


























O5 


Oi 


O5 


O5 


CT> 


CT> 


O5 


O5 


0) 


o> 


O5 


O5 


O5 


00 


00 


00 


00 


00 


00 


00 


00 


00 


w 


00 


00 


00 


00 


<<r 


-<f 


co 


c~ 


I> 


* 


?1 


<N 


CN 


CO 
<N 


CO 
CN 


Tf 
















Date of 
Completion 
of Mobiliza- 
tion. 






















f 


-* 1 


Tf 




O) 


CT> 


CT> 


o> 


o> 


O5 


C7> 


C7) 


0) 


CD 


C75 


O) 


O5 


00 


00 


00 


00 


00 


00 


00 


00 


00 


00 


00 


00 


00 


CD 


M 


<N 


IN 

CN 


CO 


** 


CO 


05 


CO 


o 

<N 


CM 

<N 


CN 
CN 


CN 












Place of 
Assembly. 






























Dublin 


Aldershot . 


Burscough 


Woolwich 


Portsmouth 


Chatham 


Colchester 


Woolwich 


Chatham . 


Woolwich 


Woolwich 


Woolwich . 


Aldershot 


Commanding Officer. 


Lieut.-Colonel C. Dalton . . 


Bt.-Colonel M. P. C. Holt 




^ 

a 
fa ' 
co 

13 
a 
o 

s 

-4-> 

3 
U 

3 


Major Babington . . 


15 
% 

D 

I > 


V 

WJ 

V 

3 

a 

V 

H! 

C/J 


W. H. Whitestone 


s 

rt 

^ 

S 
H 


->j 
-> 
o 
u 

CO 

a 


1 

"3 

n 

^ 


to 

a 
^ 


a 

1 

1 > 

d 

H^> 


M 

u 

-3 

T3 

$ 

PP 

d 
u 
o 

't? 
g 




H-l 


fa 


O 


J 





i) 


C 

o 


V 

c 




B 

c 
o 


3 

c 
o 


3 

o 


4) 

a 
o 


3 

a 

o 


8 




c? 

-i-> 

4> 


d 

-i-i 
B 


c? 

(-> 

3 
4) 


o 
O 


o 
O 


cS 


c? 


c? 


3 
01 


3 
4) 


3 
4) 


3 
4) 

a 


3 
4) 

3 


J 


3 


h-1 


J 


tJ 


3 


4J 

a 
P 


























Convales- 
cent 


-*j 

-0 

a 

D 

Q 


** 


CN 


CO 


* 


1C 


CO 


r^ 


00 


C3i 





~ 


CN 


1 


o 
fc 


1 


o 
fc 




fc 







S5 


1 


1 


1 


o 

K 


O 

fc 



362 



MEDICAL HISTORY OF THE WAR 







'O 






3 






8 






_o 






a 






gl 






1 






si 

QJ 3 

HH C 


(U 

i 


oJ 

1 

g 


1 

13 










o 


4-* 






s 


K 


P3 


JD 












a 












o 












'43 












o 








c 




c 
o 


0) 
Cfi 






d 1 

4J C Qj 

HO " 

SI 

a -fl 


t 

n 


+J 

1 

3 


f 

rt 






S 3 

CO _Q 


W5 


W 


tN 






<U P- 






O 






"rt U 


Tf 


* 


S5 






Q ^ 


S 


S 


5 






"rt 


^- 


S" 


1 






Q 


co" 


co" 




co 

^i 


C/5 






J-^ 


IP^ 


k 


|Jg 










O 


2 








o 


** 


In 


fl ft 


^ 


* 


a> 


i 


(/} 


*o '-O 


JJJ 


> 1 


w 




"S 


c-sls 

g euo-^ 





g. 


O 
SQ 


^ 


5* 










'tt 



CO 


J2 


CN 





T) 
C 
CO 


* 










C 


V^, 


.0 






. 


O 

9 


0^ 


"o 








8 


42 


-^ 









w 


!S 


^ 


^S 
8 6 




; 


b. 


*^A 

Q 


^ 




O 




S 




^t 


E| 


1 
& 


1* 


|| 


1 


M 




TJ 


g 


T- ( O 





ry-. 




^j 


*7 


-4"* 





* 




^< 


^< 


O CJ 


Ji 












fi 








; 


3 rt 
^3 *- 


>5 










'?.s 








irt 


' 




V <r> 








a 

O 


^ 


^ 


5 






u 


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C 






c 


^J 


1 


00 "* 






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^ 


CO 

C3 


o ~y 






c 


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"^ c3 






3 


^H 


^2 


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s 






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1 


j 


PQ 


11 






^ 


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h 


S s 








^ 




rt-^3 








3 


1 


W Cfl 






'2 


j 


CN 


II 






53 


6 


6 


w.| 





a 

















|_ rt 








o & 


d 




c 


MH Q 


CD 




0) 


Vt 










Q 







K 






S 










o 




Q 


"o . 


t 

2 


CO 




0- 
1 


I? 




5 




5 


r3 -^ 

s is 

co ,h 




O 
Crt 




1 


5 6 




1 1 


Q 


cJ 




"rt 




Q 


C co 

S-l O _N 


5 




s 


fl^ O *O g 


: ^L 




S" 


(31** 


-c5" 




c5" 


O **H 


f^ 




^H 


o o 








o 


V 


-> 
o 


/ 


11 




'S 




PH^ 


1 


1 

^>^_ 


\ 




C 


: 






i 






_ 


en 


t 


^ 


4) 


S 





Q 


O 


^J 




4^ 


Sfi 
O 


M 




i 

3 


c 


K 


h 

_O 


S 


-3 


^ 


">, 


* 


9 




H 


P5 


S 

a 

cS 


c 
o 

s 


c/i 

W 


6 




1 


'c? 


'cT 


'S 




c-i 


co' 


P 


6 


6 


o' 








S5 



APPENDIX A 



363 



d 








1 








P^ * 

1 


avre. 


avre. 


IH 
S 


S 


W 


W 






G 


G 


G 


, 


O 


O 





o. 1 

S * 

&1 

t> J3 

11 


Southampt 


Southampt 


Southampt 


CO cS 

4-> G 










* 


* 


^ 


Q 


o" 


o" 


1 




CM 


CN 


CN 


G d 

MH O N 


2 


S 


2 


O 4j i < 


O} 


03 


03 


4) 4>;3 C 


T-H 


^^ 


T^ 


21** 


00" 


WT 


i/T 


Q 








0*0 








<4H >^ 

O^ 


JL 


m G 
o G 


rt 4) 




O 









u 






.^^ 


i 






jq 


O 


IH 




H 


60 

-3 


1 


tn 


d 
O 

1 


1 


PQ 


-(-) 

id 


d 


a 


^ 


^ 


^ 


cS 


^ 


PQ 


h-i 




IH 


|_j 


IH 




^O 


f 


O 


-tj 

a 


i < 






P 


d 


d 


d 



G 














O 





























-2 "^ 


tj 


,j 


Q 


<i> 


w 


j 


Q, C5 


1 


1 


00 

o 


cf 


1 


g, 
o 


S 

.2 

O 


S 
O 

m 


s 


1 


3 
O 

PQ 


3 
O 


I 




o 


G 


c 


o 


G 


a 




o 

-4-> 


4^ 


o 

-J- 


3 


O 

-j 


3 


. 4_ 




a 










O 


a 


e 


a 


g 




a 


tJ S p^ 

tt o 


d 


d 




n 


- 




O -_-H 
















ft 


3 


o 


3 


3 


3 


_^ 





o 


o 


O 


O 


o 


C rt 


C/3 






C/3 


C/5 


(/) 


^a 

i< Trl 


* 


g 


-w 





TT 


rf 




03 


03 


03 


03 


03 


O3 


d 

Q 


00 


00 


00 


00 


00 


00 
















H-c 


l| 


.S ! 


il" 8 


ii 


Q) 




G 


"*"" T3 


J 


3 Q *O 


] 






VM 0.2 


U <U 


2 5 


> 22 Si 




H 4} 




O O -t-> 


fl tn 


_J_1 


r^ ""^ 


H 


( 





sll 


-2 -p. 


d + 


1 tti'jP 


J 




-i 


all 


ll 


- 


,na 


IT 


r*H M 


4 
>> 


^ 




al 


o5 


III 


|1 


^, 
[gj 


j 
S 


"*" ^ 




' 






1 




4) G 
G 


o 


o 


c 


o 


O 


O 


^S S 


tn 


tn 


"in 


C/} 


en 


tn 


PM^ 


IH 


IH 


1 


g 

2 


IH 

3 


IH 
<L> 

2 




0) 














; 


b 


G 












o 


H 














O 
M 

G 


8 

* 


O] 

^ 
^ 


1 

s 
o 


bC 
G 

'i 


ennis 


1 

O 


1 




^ 


PQ 


> 


Q 




d 

a 


^ 


Q 


CQ 


K 


& 


< 


a 

o 


W 


a 


CQ 


< 


PQ 


(I] 


O 


o 


















d 








d 


d 






s 


s 


s 





^ 


M 











W5 


CO 


P 


d 


d 


d 


d 


d 


d 



364 



MEDICAL HISTORY OF THE WAR 





a* 










^j "cS 










P'j3 


d 


c 


d 




r*H ^ 


c 


B 






Q 


s 


3 
O 


o 






w 




ti 






C3 


O 


c 








2 






1 


1 


1 


1 




ft 













3 


"3 


g 






. O 


o 


o 










O) 




gj 


05 


OJ 


1 


t/5 
* 


v-. j>> 

sf 


-M 
O 

a 






-5S 


fi . cb 


M 


M* 


^> 


V) 


^^ 


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APPENDIX B 

MILITARY HOSPITAL SHIPS AND AMBULANCE 
TRANSPORTS, SHOWING DATE OF COMMISSION, 
IN CHRONOLOGICAL ORDER 



365 



366 



MEDICAL HISTORY OF THE WAR 



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APPENDIX B 



367 



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368 



MEDICAL HISTORY OF THE WAR 









ACCOMMODATION FOR SICK AND WOUNDED. 


Period of Service. 


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APPENDIX C 




(Some of the hospital ships were destroyed after they had been 
classed as ambulance transports) 



(1735) 



BB 



370 MEDICAL HISTORY OF THE WAR 

H.S. "ANGLIA." Mined off Dover on 17th November, 1915, in the 
afternoon ; 14 officers and 374 men, sick and wounded on board; 
9 officers and 244 men were saved by destroyers, patrol boats, etc. ; 
5 officers and 128 men were lost, also 1 sister and 9 men of the 
R.A.M.C. staff. 

H.S. " GALEKA." Mined off Havre on 28th October, 1916, at 6.10 a.m., 
in a strong gale and heavy sea ; no patients on board ; 19 R.A.M.C. 
orderlies were killed in the initial explosion, all the other staff and ship's 
crew were saved ; the ship was beached, but became a total wreck. 

H.S. " BRITANNIC." Sunk by mine on 21st November, 1916, at 8.12 a.m., 
in the Aegean Sea ; there were no patients on board, and the day was 
warm, with a calm sea ; all the staff were saved with the exception of 
Lieut. J. Cropper, R.A.M.C., and 8 orderlies ; the evacuation was carried 
out with difficulty, on account of the movement of the ship, which 
continued to travel for some distance before finally sinking. 

H.S. " BRAEMAR CASTLE." M