THE MEDICAL DEPARTMENT IN EGYPT.
SIR WILLIAM MacCORMAC'S defence of his Service, appended to the Report of Lord Morley's Committee on the Medical Department, is ably written, but it misses the true, point of the accusation. Whatever the ideas of the Committee, the country is not accusing the Army Surgeons in Egypt of neglect, or of want of sympathy with the soldier, or even of allowing a high rate of mortality ; but of a certain helplessness, from which sick soldiers suffer always unnecessary torture, and often unnecessary risks. That this helplessness, however begotten, was displayed in Egypt, follows irresistibly from the evidence prematurely published in the Times. What, in fact, can be the answer to Lord Wolseley's statements, except the impossible one that he is, for some unknown motive, telling deliberate falsehoods ? He declared before the Committee that he inspected the hospital at Ismailia, with every desire to make allowances ; that he found the sick soldiers lying for the most part on the ground, that they were tormented by the flies, which they had no whisks to keep off ; and that the bread served to them was, by the admission of the medical officer in charge, "unfit for human food." Rotten dough was, in fact, given to men in diarrhoea and fever. All this while, bread was procurable in any quantity in Ismailia. No one would have objected to an order for good bread, and an application to Lord Wolseley himself would have at once elicited sanction covering any sort of pecuniary responsibility. In 'Cairo, matters were even worse. The population of Cairo is 300,000, and everything is procurable there, yet,— " I found very great fault the first day I went to the hospital in Cairo, and I found there again every man lying on the ground. At
the same time, I went to see Lady Strangford's hospital am not quite certain as to how many days she may have been there. At all events, I found her hospital all ready to be opened, and I found in-every room, for the number of patients in the room, a very neat,. nice little bedstead allotted to each. I asked her where she got them, and she said, I bought them in the town, and I can get you any quantity you like.' I said, ' bow much did you pay for them Pi and she told me it was three francs apiece—or 2s. 6d. for each bedstead. It was made out of the stalk of a palm-leaf, and a charming bed it was. I cannot fancy a sick and wounded man wishing for a better bed I was very angry with a hospital doctor the first day I went over the hospital at Cairo. It was on a Saturday, and I found the hospital very dirty. I found the men, as I have already said, lying on the ground, and lying in those filthy dirty clothes that they had fought the campaign in. They had no change of clothes, and they seemed to have very little opportunity of washing themselves. There was a washing room, but it was very imperfectly provided with basins. The ophthalmic cases, too, were put in a tent outside the hospital in a garden, I think about as bad a place as it could possibly be for them, on account, of the flies, which were so troublesome that I cannot give you any description of them, except that they were like the plagues of Egypt. They were in myriads and myriads, and they covered everything. You saw the poor sick men asleep, with their faces undistinguishable in some instances by reason of the quantities of flies on them. I have seen a man lying awake, trying to brush them off with his hands, and I said to the medical officer in charge, Why do you not go out in the town and buy whisks ? Every little dirty Egyptian boy has got a whisk to keep the flies off ; why cannot you go and buy them for a few pence ?' He said, I have not got any myself, but I have applied to the Commissary of Ordnance to get them' I said, Never mind the Commissary of Ordnance ; go out and bay them yourself, and I will pay for them' Several other faults I found with him, and I said the same thing, Why do you not go out into the city, and get everything you want ? ' I said I would come back in a week, and I came back in e, week, and I fond small supply of those whisks, but very few with the men, and I naturally was very angry ; but he sheltered himself behind the Commissary-General of Ordnance, that the Commissary of Ordnance had not supplied them. And the same thing with regard to the mosquito-curtains."
In the face of statements like that, what is the value of Sir W. MacCorraac's argument that the ratio of mortality, especially from operations, was very low It was low, but the use of surgeons is not only to ward off death. So was the French mortality in Tunis very low. What happened there daring those hideous months of the first occupation was not that thousands of conscripts died, but that thousands were invalided, and that the distaste for military service throughout
France was intensified to a degree which perceptibly affected the policy of the Government. In every village of the south there was some peasant's son broken for life as a labourer. It was just the same in Egypt. The mortality was not great, the arrangements for carrying off the wounded were admirable ; but the soldiers, once sick, were left in so needlessly miserable a condition that an unnecessary proportion were ruined in health, and that wherever the convalescent men may go, a dislike for the service is spread abroad most injurious to recruiting. Soldiers, as the whole history of the campaign in the Crimea showed, do not dread the fighting, but the other incidents of warfare, and in particular the needless miseries of bad supplies and suffering when sick. They feel these more even than their officers do. Englishmen of the lower class, though curiously stupid about some sanitary laws, look upon their strength as their capital, are morbidly sensitive about any decline in it, regard decent food as its first source, and as all hospital nurses can testify, think decent treatment in sickness as of the last importance. They did not get it in Cairo, and as the country and the Army chiefs intended they should get it, it is reasonable to ask why. It certainly was not from any wish to save money, or any impediment of circumstances, or any of that general indifference to the men which prevailed in Tunis, and which will be found by careful observers in every conscript army. The country did not care what was spent on hospitals, money would in Egypt have procured any appliances required—Lady Strangford did procure them—and as to indifference, if there is a fault on the subject, either in the officers or the people, it is that they are too -ready to fall into a passion of pity, so ready that a constant feature in the situation, the physical exhaustion of the surgeons, is too often forgotten. We have read complaints of delay in treating the wounded which must have seemed to the surgeons engaged almost infamous, they being simply worn out with thirty hours' of unremitting toil. People talk of a field hospital, and do not realise to themselves what the scene is, when perhaps five hundred men are brought up, each requiring either an operation or scientific bandaging taking nearly as much time, and there are not perhaps six men present competent to perform it all. Their assistants are no help, they must work themselves, and they do, to be told, after perhaps ten hours of the most cruel and responsible labour, that Corporal Blank lay those ten hours unattended. Somebody must wait.
We believe that there are two reasons for the constant failures in hospitals during a campaign, failures not infrequent even in India, where organisation should be perfect. One is, that the headship of the hospital, its internal care, is thrown far too much upon the medical officer in charge, who is worn out with the strictly professional part of his work. 'Re must be absolute, of course, but he needs under him some one much greater than orderlies, a gentleman who can do in the hospital all that a head nurse and a secretary combined can do in a London hospital,—who can be responsible for expense, for cleanliness, for cooking, for everything for which a purser is responsible in a ship. He should be the Medical Commissary on the spot, and his signature, countersigned by the surgeon in charge, should be final warranty for any expense, or any order to a hospital orderly, or any arrangement whatever not forbidden by the General, who, of course, must remain supreine. Whether he should be a military officer, as the Committee suggest, we do not know, though his rank and his liability to court-martial may be convenient; but we do know that he should be a gentleman, and should not be a doctor. If he is not the former, he will not be obeyed ; and if he is the latter, he will be drawn off as an assistant in the professional work, which often seems in such a scene, a scene of incessant and cruel emergencies, so /much more pressing. The other cause is the " helplessness," as we have called it, of the Medical Service itself. This is
not in full measure its own fault. The Surgeons are not liked at Head-quarters, they are not regarded as fighting men, their interference is resented, and their claims to rank in the Army are detested, till they come to feel themselves perpetually on the defensive, and grow not only timid about breaking through regulations, but sulkily resolved not to do it. They are made harder by training than civil Surgeons, that is, more accustomed to find certain evils incurable, and to deal with patients in masses, instead of as individual friends ; and this treatment hardens them still more, till they grow to care sincerely only about " treatment," the branch of their art in which they feel free and unwatched by non-professionals. The remedy for this is to give them more authority in their domain, and at the same time more responsibility. The medical officer who does not provide beds for his sick when they are procurable should be broke, as an officer would be for crassa negligentia ; but his order for pay for them, checked as above, should be as absolute on a campaign as Lord Wolseley stated that his own would have been. He should be encouraged, not snubbed, for spending for his men, and at the same time held responsible if they suffer. At present, the fear of the Regulations is on all surgeons to such a special degree, that the conduct of which Lord Wolseley complained at Cairo would have been the conduct of two men in every three, and the third man would not have been a popular surgeon with the Military Chiefs. He would have been considered one who habitually took too much upon himself. The spirit of independent decision needs to be fostered in the Department, and it can only be produced by requiring and authorising greater independence of action.
We suppose we need not, at this time of day, defend ourselves from the charge of attaching too much importance to this matter. We are not in the least disposed to coddle the men, or to suppose that war can be made comfortable for private soldiers. But in every army sickness is as much to be dreaded as the enemy, and in a modern European army its moral effect is even worse than its effect in reducing numbers. The men know what is possible, they accept wounds not only as things inevitable, but as things carefully and liberally paid for ; but there is no requital for sufferings from sickness, and they produce, not only among the men, but in their homes, a dangerous distaste for military service, which it costs us every day more and more to remove. Already we pay more than any people in the world, except the Americans. Already there are signs of a possible agitation against " punishments," which, if it developed, would be an agitation against discipline ; and if an opinion once spreads that the sick soldier is a broken soldier, we shall find every difficulty increased threefold. To spare expenditure on the Medical Service, or to allow it to be enfeebled by routine, by want of authority, or by failure to punish neglect when authority has been granted, is one of the worst of follies. The doctor in warfare should have power, and be held responsible for using it with his commission.
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