TERRITORIAL HOSPITALS AT HOME. [COMMUNICATED.]
THE hospitals abroad where our sick and wounded are cared for are always in our mind, bat it may be of interest to consider what happens to our wounded soldiers
when they reach this country and are conveyed by ambulance trains to their final destination. And while we are hearing every day of the splendid work done by the Territorials in the fighting line, it will also be of interest to remember what the equally patriotic Territorial nursing sister does in the service of her country.
It was in 1901, when the Territorial system that is so closely associated with Lord Haldane's name was set on foot, that the medical part of the organization was perfected by the Director-General of Medical Service, Surgeon-General Sir Alfred Keogh. Constantly at that time were speeches made describing the distribution of hospitals, field ambulances, cavalry field ambulances, Ix., and it was the work done then that has enabled the work being done now to be carried out practically without a hitch. In those days, when appeals were being made to the medical profession, the Red Cross and St. John Ambulance Societies, and the nursing service of the country, the scheme seemed somewhat remote. Many people said : "It is all right to organize, but don't worry us about it, and, above all, don't ask for money." And money, anyhow, was not asked for; the organization was on a volun- tary basis right through, excepting as regards certain necessary expenses in equipment. The personnel in peace time was entirely unpaid.
It was, however, clearly explained that the Territorial Army would not be an army unless it were complete in all its parte, and that the Medical Corps was one of the essential portions of a modern army. What was the result? The medical organization was soon completed, because the medical profes- sion responded most fully. In each division an Administrative Medical Officer (T.F.), a Staff officer, and a sanitary adviser were appointed, who had each his place at headquarters. Then came the Regimental Medical Service, and for each division there are three field ambulances, while each mounted brigade has a cavalry ambulance (a field ambulance is not an insignificant body, for it has a personae/ of over two hundred, with the necessary waggons or motors, tents, &a.). Doubtless many of these units were then incomplete, but the organiza- tion was complete, and the filling up was comparatively a simple business.
The scheme contemplated had primarily reference to a state of war in our own country, since it was intended to meet the requirements of the borne defence troops ; but it has proved just as useful in the case of troops serving abroad and using this country as a base, as we have reason to see now. It is the power of expansion that is the strong point of this na of other portions of the Territorial organization, and this medical service has infinite capacity in this direction; indeed, in these times it is expanding every day.
The clearing stations and base hospitals are, of course, abroad, but the patients, as we all know, are brought to the hospitals in this country as speedily as possible. Out of the unrestful atmosphere of war the wounded recover much more quickly than they could within sound of the guns, and the overstrained nerves far more speedily gain a state of equilibrium. And these hospitals were ready whenever they were wanted.. The positions in which they should be placed had been a matter of serious consideration years ago, but finally twenty-three centres were selected from all over England, Scotland, and Wales, usually in places where, owing to the presence of a University or great training school, the best skill was to be bad. Each hospital, planned to contain five hundred and twenty beds, was selected and earmarked for its purpose ; sometimes it was a workhouse infirmary which could be vacated in emergency, sometimes a great school or other institution ; but whatever it had been before- hand, in most cases a great deal of adaptation had to be carried out in order to make it thoroughly up-to-date. A very few lucky centres found now buildings ready to hand. We know all these hospitals now, and see how successfully the work of adaptation has been done. A commanding officer is, in all cases, placed in charge, with a Registrar, Quartermaster, &c., to help him. On the declaration of war the physicians, surgeons, sisters, and nurses were at once called up, and also a staff of orderlies obtained through the offices of the St. John and St. Andrews Ambulance Associations. Thus, directly the Army was mobilized these hospitals sprang into being as by magic. The surgeons, who were men whom one had known as professional men of distinction in civil life, assumed their military rank and uniform. The orderlies appeared in their
places, and a complete regiment of matrons, Meters, and nurses left their civil duties to take up the work they had pledged themselves to do. Many of the male professional staff had given much time and trouble to studying the work that lay before them. They had been inspired by the idea of doing a special work for their country even though unable to serve in the ordinary way, and the idealism of the leaders was carried down to the rank-and-file, although few expected that the call for service would come so soon. The matrons (principal and acting) had undergone courses of training at one or other of the military hospitals, and thus obtained the special knowledge required to deal with militaryconditions and manage a staff where orderlies take the place of probationers. The principal matrons, who are advisory and unpaid, are usually the matrons of great civil hospitals. The whole of the huge nursing staff had already volunteered and was wearing the badge designed. by Queen Alexandra, and in cases of official func- tions the uniform. These were called up by the Matron-in- Chief through the Principal Matrons from their hospitals or nursing homes, and before one realized that hospitals were needed, were occupied in getting things set in order and nursing the sick Territorials. In a few weeks a continual flow of wounded soldiers poured in from the front, and this now has in these later days been continually increasing as our armies have increased_ But as to hitch there was none. Just as the Territorial organization bore the strain and equipped and sent out its units complete, so the hospitals increased, doubled, trebled, and sometimes quadrupled as time went on. Instead of the matter of eleven thousand beds, there are now over thirty-two thousand, and the numbers go on increasing. The nursing gaff, which was two thousand seven hundred and sixty in peace time, that is, a hundred and twenty for each hospital, could not, however, increase in proportion, because there would not have been enough nurses to go round, especially as a percentage of the Territorials is allowed to volunteer for foreign service. So that the old system of nursing only by fully trained nurses has had to be changed during the past months, and in the home hospitals a proportion of carefully selected members of Voluntary Aid Detachments has been introduced which has replaced one-third of the staff, two V.A.D. members replacing each trained nurse taken away. Two or three thousand of these are already being used, and there will be need for many more.
This is, roughly, an account of the Territorial nursing system, as distinguished from Queen Alexandra's Imperial Military Service, which, besides its work abroad, has large military hospitals at home, many of them just now being organized. There is much more work being also done through the Red Cross Society at home as well as abroad, and through its Voluntary Aid Detachments it has an important part to play in the Territorial organization. These Voluntary Aid Detach- ments were organized and trained in first-aid and nursing work at the request of the War Office in order to complete its scheme of medical aid. This was done soon after the first part of the medical organization was completed. The members have become probationers in both aorta of hospital—those supported. by Government and those run by the Red Cross Society. They have undertaken the nursing and running of countless convalescent homes and auxiliary hospitals as well. On the declaration of war the detachments were brought directly under military control, and without the help of these organizations the difficulty in nursing the wounded would have been very great. The activities of the Voluntary Aid members are indeed innumerable; the ambulance trains are "refreshed" as they pass through stations by cheery white- aproned members bearing cups of bovril and coffee. The male Voluntary Aid members are ready to do any helpful job that comes to hand, even if it is only to take a sick man out for a drive. Many man have enlisted as R.A.M.O. orderlies, others have gone to the front with ambulance motors.
One longs to say something of the human element in them, wonderful military hospitals of to-day. There is an atmo- sphere of cheerfulness throughout them that seems to conquer pain and suffering, and help the sufferers to look at the bright side of their troubles, hard as they of ten are. Even those who are " prisoners " tell us they are "sehr wohi behandelt," and can ask for nothing better ; and the cheery little Belgian, in the past months when Belgian wounded were taken charge of in Britain, was ever ready to join in singing "Tipperary." "I'm ashamed of myself," said one weary
soldier back from weeks of the trenches and continual screech- ing of shells, whilst the tears ran down his checks, "but I couldn't help it when I saw you all standing there and every- thing so bright and warm ; it just went to my heart." And the sister understood, and felt proud of her hospital and glad of the service she was permitted to render to her country.
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