§ VISCOUNT BURY, in rising to cal. the attention of the House to -au Report of the Committee on Army Hospital Services, and to move to resolve—
That while the individual medical officers in Egypt behaved admirably well, the system under which they worked did not successfully stand the strain put upon it; that the military authority exercised by medical officers is inconvenient, and that discipline in hospitals ought to be administered by combatant officers, leaving to the medical officers medical duties only also that medical officers ought to be attached to regiments instead of being detailed for duty day by day from station and other hospitals,said, the subject was one entirely independent of Party, for the care of our 2 soldiers in war was a matter which nearly touched us all. In 1873 a very great change took place in Army Medical Administration, a change that was for the first time put to the test in the war of last year in Egypt; and he thought all must acknowledge that it did not altogether stand the strain then put upon it. Before the new organization of 1873 the system was purely a regimental one, a surgeon being attached to each regiment. In 1873 a system was introduced under which general hospitals were instituted, and all medical officers were attached to these hospitals, and detailed day by day for duty. Medical officers formerly attached to regiments were no longer so attached, and the Medical Department became genes-al in its character. The Service was divided into two parts—the Army Hospital Corps and the Army Medical Department; the latter supplying dressers and servants generally, and the former supplying nurses. The exception to this system was the House- 3 hold Cavalry, of which the Medical Service was still regimental. Medical officers had very important duties to perform, besides the treatment of sick soldiers, for they were responsible for the organization and management of the hospitals to which they were attached in peace or war, and for the control over the inmates, whether patients or otherwise. These officers had no opportunity of carrying on the regimental life they formerly enjoyed, for they lived out of barracks, apart from the soldiers, and thus they had no opportunity of learning discipline. It was found in the Egyptian Campaign that the new system had somewhat broken down, and that, although the officers individually were unexceptionable in a medical point of view, they were unable, owing to defective training, to enforce discipline in the hospitals. This appeared from the recent Report of the Committee on Army Hospital Service. With regard to the remedy for the existing defects, he was disposed to agree with the two Members of that Committee who dissented from the Report—namely, Major General Hawley and Sir Robert Loyd Lindsay. They proposed two remedies—first, a return to the regimental system, so far as attaching a medical officer to each unit of the Service was concerned; and, secondly, what he himself suggested in his Motion—namely, that the discipline in hospitals ought to be administered by combatant officers. Then they went on to point out the disadvantage of conferring upon medical officers military rank, while exempting them from military discipline. This was the crux of the whole thing. They pointed out that the regimental system was adopted by every Continental Army, and that it was, moreover, the system that the British Army, as a matter of fact, reverted to in time of war. They accordingly advised a partial return to the old regimental system, as he had already stated. He would now proceed to deal with the evidence before the Committee; but, first, he would like to say that the conduct of the medical officers in the late campaign was beyond all praise, that the individual officers did well, and that there was nothing whatever to be said against them. Everything they could do was done; and in what he was about to say he had no intention whatever of casting blame upon individual officers, but only 4 on the system. Lord Wolseley, speaking of the hospital at Ismailia, said in his evidence that the medical officers themselves worked individually remarkably well, and that their devotion to the sick was admirable. There was, however, a gloomier side to the picture disclosed in the gallant General's evidence. Lord Wolseley said that he visited the hospital after the two fights of the 24th and 25th, and that he found a great many things deserving disapproval, which led him to form the conclusion that the system was bad. At the Cairo Hospital he found the same defects, and he believed that there was no excuse for them. After the third day the hospitals should have been as well supplied as a hospital in London, there being no difficulty about obtaining any amount of servants, food, and necessary materials. He mentioned that he found the men lying on the ground in a filthy condition, and that the cooking arrangements were very inefficient. Colonel Knox also gave evidence to the effect that the hospital at Cairo was not well administered; that there was a want of organization and an insufficiency of men to do the work of the hospital. According to the evidence of the Colonel of the York and Lancaster Regiment, 18 wounded soldiers belonging to that regiment were almost unanimously of opinion that the nursing in the hospitals was very indifferent, and that there was very little discipline in the establishment. They were, however, quite satisfied with the manner in which the surgeons performed their duties. Thus, while no fault could be found with the surgeons' knowledge or treatment, the discipline maintained among their subordinates was very unsatisfactory. It was said by the surgeons that the hospitals were merely field hospitals, in which the same perfection of organization as existed in fixed hospitals could not be expected. Lord Wolseley, however, described the hospital at Ismailia as a base, and not a field hospital. With regard to that hospital, therefore, the argument of the surgeons fell to the ground. The Commander of the expedition said that while the medical officers were capital doctors they certainly were not soldiers, and had not the power of maintaining discipline among their men. The great fault which Lord Wolseley found with them was that they did not assume the responsibilities which their high position 5 imposed upon them. That bore out his contention that medical officers ought to be confined to purely medical control, and that combatant officers ought to be placed in the hospitals to maintain discipline. Lord Wolseley stated that the medical men were entirely wanting in initiative, and that, when asked why they had not bread, they said that the Commissariat had not given it, and why they had not stretchers, that stretchers had not been supplied. His Royal Highness the Duke of Cambridge had said that of everything connected with the Medical Department the medical officer ought to have charge, but of everything beyond that he could know nothing. His Royal Highness added that he thought it the greatest misfortune that the medical officer should attempt to do that to which he had not been brought up. Colonel Maurice, who had been Deputy Assistant Adjutant General, said that as he was known to be an officer on the Staff of the General Commanding-in-Chief nobody would think of treating him otherwise than well; and yet, while lying wounded in the tent, he was woke up three or four times in the course of a night, once because the doctor wanted to know his name. Colonel Maurice said that in speaking of medical officers he was speaking of his own personal friends, men for whom he had the greatest personal regard; but he felt it his duty to say that the system was by no means perfect. he said that medical officers did not sufficiently recognize their functions at the head of an organization in which a number of persons were to be made to do their duty. Colonel Maurice related some stories in corroboration of what he had said. One was that he told a servant to get him some food, and the servant went to the cook, who, in a very uncivil way, said he would not work for an officer, or something to that effect. When the surgeon was told what had occurred, lie said it was true that an incivility had been committed; but Colonel Maurice must remember not only that he was an officer, but that he was his patient. Colonel Maurice was entirely of opinion that the discipline of the hospitals ought to carried out by combatant officers, and not by medical men, on account of the want of knowledge on the part of the latter. And Lord Wolseley said he was convinced that the presence of a military officer in the hospitals would have gone 6 far to correct all that was wrong. It would be unfair to blame a man for not knowing what he had not been taught, and what lie had no means of knowing. Their Lordships would be of opinion that medical officers had no opportunity of learning discipline. His Royal Highness said he thought that a man should be an officer in the Army to know what discipline was. If their Lordships turned to Appendix 24 to the Minutes of Evidence, they would find a Report on the system employed in the different Armies of Europe. That system combined the advantages of the departmental and regimental systems. The regiment officers and those of higher ranks in this country had unanimously expressed an opinion in favour of the adoption of that system. Owing to the frequent change of medical men the present system fostered malingering, because the medical officer was not attached to a regiment sufficiently long to be able to learn anything about the men with whom he had to deal. Another evil was that Commanding Officers rarely visited their men in hospital, and, in fact, lost sight of them from the time they became ill. The Report of the Committee which sat at Aldershot on the 6th of February showed that of the 14 officers in command of regiments, who were examined before it not one gave evidence to any other effect than that it was desirable that medical officers should be attached to regiments, and that the old system should, thus far, at any rate, be reverted to. The evidence showed that the system was so far in fault that the medical officers did not administer discipline, because they themselves were not, in a military point of view, disciplined men. Without going into other details of the Report, he might point out the practical difficulty that existed in obtaining good hospital nurses. These men were enlisted on the same terms as other men were enlisted into the Army; they were not properly trained, and were, in fact, exceedingly bad nurses. Another point was the presence of lady nurses in hospitals. Everybody knew the admirable services they rendered; and it would be ungracious not to pay a tribute to the excellence of lady nurses in the hospitals in Egypt. Time, however, did not admit of his going into these details, and he therefore concluded with moving his Resolution in the terms of which he had given-Notice.
§
Moved to resolve—
That while the individual medical officers in Egypt behaved admirably well, the system under which they worked did not successfully stand the strain put upon it; that the military authority exercised by medical officers is inconvenient, and that discipline in hospitals ought to be administered by combatant officers, leaving to the medical officers medical duties only; also that medical officers ought to be attached to regiments instead of being detailed for duty day by day from station and other hospitals."(Viscount Bury.)
THE EARL OF MORLEYsaid, it was quite unnecessary for the noble Lord opposite to apologize for bringing this question before the House, for it was a question of the greatest importance to the Army at large. Neither could he complain of the manner in which the noble Lord had introduced the subject. The noble Lord in his speech disclaimed any intention of making an attack on any officer, and he had certainly carried out that intention. The ability of the medical officers in Egypt had been acknowledged by Lord Wolseley himself, and he concurred with the noble Lord opposite in acknowledging the admirable work done by the lady nurses in Egypt, and wherever else their services had been required. Before he spoke on the remedies proposed by the noble Lord for what he considered the defects of the present hospital system of the Army, he desired to make a few comments on the working of the system during the late campaign in Egypt. The noble Lord had referred to the Report of the Committee. It was admitted that there were some defects in the administration and general management of the hospitals during the recent campaign; but it was necessary to bear in mind the remarkable nature of the service. The peculiarity of the campaign was its extreme rapidity. On landing at Ismailia the Army had at once, for military reasons, to move into the Desert, and before the hospital equipment bad been landed. The noble Lord had quoted an answer given by Lord Wolseley with regard to base hospitals. It was not intended that there should be a base hospital—which was a furnished hospital fitted with bedsteads and other furniture such as was supplied to general hospitals—at Ismailia, the exact time the troops would land there being uncertain. Accordingly, base hospitals were established at Alexandria, Cyprus, and (bozo, the hospital at Is- 8 mailia being fitted as a field hospital only. Then the noble Lord had referred to the evidence of Colonel Maurice but he thought that that evidence should be compared with the evidence subsequently given by Surgeon Major Veale before the noble Lord formed an opinion on several of the points on which that officer bad animadverted. With regard to the medical results of the campaign they wore somewhat remarkable, and showed that even if there was in some instances undue delay it had not been productive of serious consequences to the sick. He would take the period from the 17th of July, when the first battalions landed in Egypt, to the 10th of October, the date at which the Cairo hospitals were converted into station hospitals, and the Army became an Army of Occupation instead of an Army in the field. Between those two dates there were 378 non-commissioned officers and men in hospital from wounds in the field. Of these only 11 died. Then there were admitted from other causes 7,212 non-commissioned officers and men, of whom 79 died. Thus the total number of wounded and sick was 7,590, of whom only 90 died. Of those who had been invalided from Egypt there died elsewhere before the 10th of October 21 who had been wounded in action, and 94 from other causes, making a total of 115. Therefore, out of 7,590 admitted to hospitals the number of deaths was 205 — 32 wounded in action, and 173 from other causes; these numbers being exclusive of the 82 killed in action. The 37 deaths on the passage from Egypt were included in the deaths stated to have occurred "elsewhere." He did not think that these figures were at all unsatisfactory. There was a total absence of pyæmia, gangrene, or other diseases peculiar to hospitals; and it was a remarkable fact that there was not a single case of loss of sight from ophthalmia, and that this disease was, by skilful treatment, almost completely stamped out. These facts, especially if compared with the medical history of former campaigns in Egypt, showed, whatever defects there were, that medical officers were careful and skilful. He was not prepared to question the statement that the Army Hospital Corps was not in a satisfactory condition; there were admirable nurses in it; but, at the same time, there were 9 some who were indifferent. As a rule, they had not had sufficient training as nurses to make them efficient. In the opinion of some, the only means of improving the nursing was to employ to a much greater extent female nurses; and he agreed that, where circumstances permitted, this should be done; but it was wholly impossible to employ female nurses in military hospitals to the same extent as in civil hospitals, because there were diseases and circumstances in connection with which women could not be employed. Unfortunately for the Army Hospital Corps, the patients in all our civil hospitals were nursed by women. It was a disadvantage to the military hospitals that there was no large body of men from whom nurses could be drawn in cases of emergency. The whole supply of male nurses and hospital orderlies must be maintained by and for the Army. The noble Lord appeared to have paid too little attention to the paragraphs of the Report relating to the Army Hospital Corps, to which he attached more importance than to any other part of the Report. The Committee recommended that the men should have more training as nurses, and also that there should be a better system of promotion, so that higher appointments in the wards might be given to good nurses. He hoped that when the Secretary of State had had time and opportunity to consider the suggestions that had been offered, there would be improvements made in the pay of nurses, and in the co-ordination of the different branches of the Corps. The Committee over which he had the honour eventually of presiding was appointed originally with reference to the condition of the Army Corps in South Africa; and its labours were approaching completion when the larger questions arising out of the Egyptian Campaign were referred to it. As regards the duty of the medical officers in charge of hospitals, and the necessity for having combatant officers at the head of such institutions, there were, undoubtedly, differences of opinion; and he admitted that the weight of military authority was on the noble Lord's side. But there were considerations which induced the majority of the Committee to take an opposite view. In proposing that hospitals should be presided over by a Military Commandant, he presumed the 10 noble Lord did not mean to include, besides the general hospitals, the numerous station hospitals scattered over the country.
§ VISCOUNT BURYYes; I did.
THE EARL OF MORLEYThen his suggestion would be difficult to carry into effect, because there were 182 station hospitals in England and Ireland alone; and it had never been proposed that these should have Military Governors like Netley. The Committee unanimously came to the conclusion that it was undesirable that there should be a double control in any instance. They felt the great importance of unity of control, and that it should be vested in the medical and not in the military officer. They feared the evils that might result from friction between the military and the medical authorities. The Military Commandant at Netley, as long as the discharge depôt—now removed to Portsmouth—was attached to the hospital, had duties to perform in connection with this depot which rendered it necessary to have an officer of high position; and even now there was a considerable amount of work done there in connection with the discharge of men invalided from India and elsewhere. No doubt, a station hospital should be under the control of the General Officer commanding the district, or of the officer commanding the troops at the station. The Committee thought that the inspection of all hospitals by au officer of high rank, specially appointed, should be frequent and searching; but that it would be far better that the administration of the hospitals in all branches should be in the hands of one responsible medical head. With regard to attachment of medical officers to regiments the Committee were not unanimous; two of his Colleagues were in favour of a return to the old system so far as the medical officers were concerned. As far as hospitals were concerned, experience had so amply shown that the regimental system was impracticable in war that it was hardly worth while arguing the question. The noble Lord would attach medical officers to every battalion and every corps of troops. He quite admitted the importance of the witnesses who favoured such a change; but a medical officer would deteriorate if his only duty were to look after healthy troops, and if he were debarred from 11 attending hospitals; and he considered that there would be considerable difficulties in the way of employing medical officers attached to corps in the station hospitals. If it were said they should be attached to regiments with the view of learning discipline, that implied that the medical officers should be young and therefore inexperienced; and if they were, that would diminish the confidence of those requiring their services. Another difficulty in the way of the adoption of the proposal of the noble Viscount was the extra expense that it would involve. This matter had been Carefully considered by a Departmental Committee which sat some years ago. The appointment of a considerable number of additional medical officers would be required, and this would cost £20,000 or £30,000 a-year. Of course, if that were necessary for the benefit of the troops, such an additional expense ought not to stand in the way of the change. In his opinion, however, the advantages that might be derived from the change suggested would not be commensurate with the cost of the experiment. He was opposed to the attachment of medical officers to regiments, because officers so attached would gain less experience than under the present system, because it would render it difficult to distribute the medical officers, so that they should severally have duties which they were best qualified to perform; because, though this was not by any means an insuperable objection, it would interfere with the roster for foreign service; and because it would involve an additional expense without securing any adequate benefit to the Army. He thought he had dealt with the two main points raised by his noble Friend, and that he had given the reasons which induced the majority of the Committee to take the views which the Report showed they did take upon these matters. Before sitting down he wished to rectify an error into which a noble Lord had fallen. A notion prevailed, and had been given expression to that day, that a gallant colonel was reprimanded for visiting some of his men in hospital. The reason of the difficulty that had arisen in the case referred to was that the visit was paid when the medical officers were engaged in the wards. During the hours when they were so engaged inconvenience would be caused if a large number of officers were to visit their men; but it 12 must not be supposed that regimental officers were prohibited from visiting station hospitals, except during certain hours, when the medical officers were treating the patients. Any prohibition of that kind would be directly contrary to the wishes of the medical officers, and obviously wrong. With regard to the charges made by the noble Viscount opposite, he admitted that improvements in the cooking and nursing in Army hospitals were required, and that other matters connected with the administration of hospitals, and with the Medical Service generally, called for amendment; but he failed to see how the defects complained of by the noble Lord would be remedied by the adoption of the proposal before the House.
THE DUKE OF RICHMOND AND GORDONsaid, he felt very strongly that of the many changes that had been introduced into the Army during recent years, of which he most entirely disapproved, the alteration in the Army medical system was, perhaps, the worst. He could conceive no system more objectionable and disadvantageous than the present; and he regretted very much that, in the Report of the Commission, it was suggested that the system should be extended to the Household Troops. The noble Earl admitted that the arrangement, in accordance with which medical officers were not attached to regiments, was deprecated by all the military witnesses who gave evidence before the Commission. Were not the commanding officers of regiments the very persons who knew best how the present system worked, and how the former system had worked? This the noble Earl admitted, and yet he came to a conclusion adverse to the recommendations of those officers who were eminently qualified to give an opinion upon the subject submitted to them. In former times the medical officer was said to be the father of the regiment. He had probably assisted at the birth of every child in his regiment, and he knew the constitution of every man and woman in it. It was to him that the young men went when they had got into scrapes. All that had been altered, and the change was a very bad one. The noble Earl said that before introducing innovations the expense that they would entail must be considered. In his opinion, if a change was desirable, on the ground that it would improve the health 13 of the Army, the question of expense was the very last that ought to be considered.
§ THE DUKE OF CAMBRIDGEsaid, that, as his evidence had been referred to in the course of the discussion, he felt bound to make a few observations. His noble Friend the Under Secretary of State for War (the Earl of Morley) had been induced on that occasion to give expression to views which were not altogether in accordance with his own. He, however, desired it to be clearly understood that he recognized fully the excellence of our medical officers, and was inclined to make every allowance for the shortcomings which were sometimes the result of the difficulties which they had to face, especially in time of war. If anything had gone astray in their Department, it was the system, and not the individuals, who were at fault. He should very much like to see the present system modified, so that medical officers, for at least two or three years, should be attached mainly to a regiment. He did not think that there was any other Army in which there was not a medical man attached to the regiments. He believed that the old system was a very good system; but, as it had been so much altered, we could not go back to anything which had been so thoroughly changed. But he thought it essential that there should be some men to whom the whole constitution of the Army should be thoroughly known. If any one of their Lordships wanted medical advice, he would not wish to put himself into the hands of different doctors. But men were now sent about so much that they had five or six different surgeons to deal with them. It was not a question of roster, nor did he see any difficulty in accommodating the roster to the requirements of the case. It was all matter of arrangement. What he wanted to see was, that a medical officer should be attached absolutely for two or three years to a regiment, and should perform all the medical duties connected with that regiment. His noble Friend had said that a medical man would not acquire medical knowledge in that way. But he did not see why medical men should not spend a portion of their day in the station hospitals. In the London hospitals the visiting surgeons only came at certain hours; and he could not imagine, therefore, how a practical difficulty could be raised in that respect. It would be a mere matter of arrange- 14 ment by the Head of the Department. Why should they not attend to the ordinary medical requirements of the regiments, and, having done that, attend also at the station hospitals? He wished it to be clearly understood that he did not object to station hospitals at all. Station hospitals, in his opinion, were very good; they were better than more military hospitals; there was more system in them, and there was less extravagance in carrying them on. His noble Friend (the Earl of Morley) also thought that the discipline of the hospital should be in charge of the medical officer. He (the Duke of Cambridge) did not see how the medical officer could understand anything about discipline. Under the old system he joined a regiment as a young man and lived with it, and he did learn discipline; but now he joined as a professional man, and was attached to some station. What military discipline could he learn there? A military medical man ought to know military discipline, quite apart from medical discipline. He could not see why the station hospital system, as it existed, should not be combined with that moderate regimental system which he ventured to suggest, and which he believed to be compatible with the requirements of the roster. But he confessed he did not think that medical men were the proper persons to carry out discipline in hospitals. He was himself President of the London Hospital, and a civilian lived on the spot, who conducted the supervision of that Establishment. A great London hospital might be compared with a military hospital; and, inasmuch as they had a civilian to look after the wants and requirements of the London Hospital, he would say that they ought to have a military man to look after the wants and requirements of a military hospital like Netley, quite independent of the medical officer who might be in charge of the sick. He regretted, to some extent, the changes which had been made. He would not say that the new system should be entirely altered; but he thought it should be modified to the extent which he had indicated. He hoped it was possible that the discussion which had taken place, as well as the general feeling in the Army, which entirely accorded with the views he had expressed, would bring about this modification. He believed the change would be very beneficial to the Army, and that 15 it would not be found out of accord with the prevailing system, which, with the limitation he had suggested, would continue much in its present form.
LORD ELLENBOROUGHsaid, that a system which was admitted not to work well in time of peace could not reasonably be expected to be successful during war. He did not wish to seek popularity by suggesting more economy, but a restoration of the late system. Everything that gave dissatisfaction to officers or men was due to the sacrifice of efficiency to economy. He would revert to the old system, as he thought that all the changes which had been made in the Army had proved to be of the most expensive kind. Nothing was more economical than sending a soldier to his duty instead of having him in hospital for six months. Ten years ago he had pointed out the absurdity of the present medical system in the Army; and he hoped that the present Secretary of State for War would make some alteration in it in the direction of the views entertained by the late Sidney, Lord Herbert.
THE EARL OF LONGFORDsaid, the fact was, the Army, with its attached Departments, had been re-organized to within an inch of its life. This very Medical Department had been under re-organization for more than 20 years. The statue of Sidney Herbert stood in Pall Mall as a grateful recognition of the attention given by a good and earnest man to this special branch of the Service. The result was that, in the Egyptian Expedition, a large staff of qualified medical officers, with subordinate assistants, and ample supply of stores, close to their ships, with no overwhelming number of sick on their hands, were unable to establish their hospital, and give proper attention to the sick for several days; and, according to the Report of this Committee, administrative defects were observed in other hospitals subsequently formed. Regimental paymasters, regimental surgeons, regimental numbers found no favour with modern Army reformers; and had been superseded by systems which, as far as he could understand, gave no satisfaction to anybody. He did not propose to go through a list of Army grievances then, and the medical question had already been sufficiently discussed; but he might mention that, having been lately present in one of their largest garrisons, in a 16 military society, he made inquiry respecting two cases, in which, by the neglect of officers to pass certain examinations for promotion, junior officers had been promoted over their heads. The answer was in language more forcible than polite—"The whole thing is so disgusting that no one cares a big D whether he is passed over or not." This was not the spirit that military reformers intended to introduce into the Army; but it was the spirit which they very generally—though he did not say universally—had introduced by their constant innovations.
THE MARQUESS OF HERTFORDsaid, that many excellent reasons had been given for a return to the regimental system, as far as was possible, and there was a strong objection to the new plan being adopted with the medical officers of the Household Brigade. He thought medical officers should be put on the same footing as the other officers of the Army.
§ VISCOUNT BURYsaid, he would not trouble the House to divide, a s he was quite satisfied with the discussion which had taken place.
§ Motion (by leave of the House) withdrawn.