THE MEDICAL ORGANIZATION OF THE BRITISH ARMY.
Each battalion at the front has a headquarters, usually in a dug-out
or a sheltered farm house close to the lines: each brigade, consisting
of four infantry battalions has a headquarters farther to the rear:
each division, consisting of three infantry brigades, artillery, etc.
has a divisional headquarters in some town, still farther to the rear,
out of shell range: each corps comprising two to four divisions has
its headquarters in a town back of this again: each army, composed of
two to four corps, has its headquarters still farther to the rear, and
the popular idea of the Tommy is that since the respective
headquarters occupy bigger and bigger chateaux the farther back they
go, away back somewhere in a town all by himself, living in a big
castle from which he operates everything, is the commander-in-chief of
the whole British Army.
General headquarters is usually a very busy place, for there are the
heads of the various services of the army, and all the orders
affecting the army as a whole are issued through it. The offices of
the chiefs of the services are business offices and are operated in a
most business-like way. The system is so perfect that it is difficult
to escape from it should an order be neglected or a duty left undone.
Among these chiefs is the Director-General of Medical Services of the
British Army in the field, General Sir Arthur Sloggett. Through him
and his deputy, General Macpherson, went all the general orders
affecting the health of the army.
At the head of each army medical service is a Surgeon-General (D.M.S.,
or Director of Medical Services), and at the head of each corps a full
colonel (D.D.M.S. or Deputy Director of Medical Service). The chief
medical man of each division is also a full colonel (the A.D.M.S. or
Assistant Director of Medical Services), and he is responsible for the
operation of the field ambulances and the evacuation of the wounded to
the casualty clearing station while his division is in the firing
line. The medical officers of battalions and the sanitary squad are
also under him.
The casualty clearing stations and the mobile laboratories, are under
the D.M.S. of the army, who is responsible for the clearing of the
hospitals by motor ambulance convoys and by hospital train.
There are normally three field ambulances to each division and one
casualty clearing station. The number of base hospitals to each
division is normally two, but as many of these are utilized as are
needed. They are scores of miles from the fighting zone, and do not
particularly concern us here.
When a battalion medical officer or sanitary officer wishes to make a
report or suggestion he does so through the A.D.M.S. of the division.
In the same way the A.D.M.S. of the division communicates with the
D.D.M.S. of the corps; the D.D.M.S. of the corps with the D.M.S. of
the army, and the D.M.S. of the army with the D.G.M.S. at G.H.Q. A
battalion medical officer cannot go over the head of his A.D.M.S.,
nor could the latter pass his D.D.M.S. to make a report or suggestion.
Everything must go up or down the system through the various heads,
and no side stepping is permitted.
The front line trenches were about seven miles from our laboratory
which was located in a town with three casualty clearing stations, a
railroad and canal. This made it possible to evacuate the wounded
rapidly to the base by means of hospital trains and barges during an
engagement.
The system which enables a sick or wounded man to be removed from the
front is simple enough. Each day the medical officer of a battalion,
who himself may be located in a dug-out in the trenches themselves or
in a cellar of a house not far behind the trenches, holds a "sick
parade" at his "regimental aid post." During a battle the wounded are
collected by the regimental stretcher bearers and brought to the aid
post.
Any soldier who is feeling unwell reports to the M.O. of the battalion
who, if the trouble is a minor one, may give him some suitable
medicine. It is one of the difficulties of the M.O. to distinguish
between a case of genuine illness and a fakir or "scrimshanker," and a
good supply of common sense and a knowledge of human nature is a great
asset in making correct diagnoses. It is almost impossible, for
example, to distinguish between a genuine case of rheumatism and a
clever imitation of it, because the only symptoms are pains, the
effects of which can easily be simulated by a soldier. If the man
shows serious symptoms he is sent back to the "advanced dressing
station" which will probably be a mile or so behind the front line
trenches, if possible in a house and on a road accessible to motor
ambulances.
If the man can walk he goes through the nearest communication trench;
if wounded he is given first aid, and if unable to walk he is helped
or carried back by stretcher bearers from the ambulance--to the
dressing station.
Some of these dressing stations taking in wounded under shell fire
were located in shell-proof dugouts. At many points light narrow gauge
railroads had been built which ran from the dressing stations right up
to the trenches. On these railways little cars pushed by hand were
used both for bringing out the wounded during a battle and for taking
in food, water and other supplies. It is, of course, impossible to lay
such railways in many parts of the lines where they would be exposed
to direct observation by the enemy, but they are becoming more and
more numerous as their value in saving time and labour in the "man
handling" of food and trench supplies has been proved. At one of these
dressing stations where the railway came right up to the shell proof
dugouts fresh shell holes in the neighborhood testified to the fact
that the work of the field ambulances is at times not unmixed with
excitement.
The cases which accumulate at the advanced dressing station are given
further treatment if required, and are evacuated by motor ambulance,
usually at night, as the road to the station is frequently under the
enemy's observation, to the field ambulance proper where they are
given further treatment or dressings as the necessity may be.
From the field ambulance the sick and wounded are cleared by motor
ambulance convoy to the casualty clearing station, or possibly in
cases of tired or slightly shell-shocked officers and men, to the rest
stations or convalescent hospitals, of which there are a number well
behind the firing line.
At the casualty clearing station the men are checked over, their
wounds redressed, operations performed, and all the work done
necessary to enable the men to be passed on to the base hospital by
hospital train or barge. These clearing stations, of which there are
usually three in a town, may keep certain serious cases for days until
it is deemed advisable to send them on.
While one clearing station is filling up and treating the patients,
the other will be sending all possible treated cases down the line.
From the base hospitals, which are near the sea, the men are forwarded
as soon as advisable by hospital ships for distribution among the
hospitals of England.
While a battle is in progress the men pass through this system so
rapidly that they may be wounded one morning and be in a hospital in
England the next.
The medical officer, of course, is attached to the battalion, and goes
everywhere with it, and under him are a number of stretcher bearers
who gather up the wounded. The advanced dressing station is merely an
advanced party from the field ambulance which itself is divided into
three sections, each of which may operate independently according to
the nature of the country. Each ambulance is self-contained, having
its own transport, and by using tents can work in an area which has no
houses or other shelter.
The casualty clearing station, on the other hand, having an
established capacity of nearly 600 beds, has much heavier equipment
and is not supposed to be a mobile unit, though it is capable of
moving with the aid of its two lorries by making repeated trips. Many
of the casualty clearing stations are located in huts which can be
torn down and moved forward and rebuilt by the engineers and
construction units.
There is also in each division a sanitary section composed of one
officer and 25 men, whose function it is to keep an eye on the
sanitation of the divisional area, report failure on the part of units
to observe the established sanitary regulations, see that the
incinerators are operated, have new sources of drinking water tested,
look after the bath houses on occasion, search for cases of typhoid
fever, etc., among the civilian population, and, in general, make
itself as useful as possible.
The British army regulations are such that each officer and man must
be a sanitarian and must not only observe the regulations but see that
others do the same; the principle underlying this system being that
"if each before his doorstep swept the village would be clean."
Consequently it is not left to the sanitary section to clean up a
divisional area, but rather to report those responsible for not
keeping it clean. In this way every man is made a responsible party,
and if the officers of any unit see that the regulations are enforced
by each man, the unit will be a sanitary one.
Naturally as the battalion M.O. is directly connected with the field
ambulance to which he sends his cases, he is most interested in the
efficiency of that unit. Since the field ambulances are under the
direct supervision of the A.D.M.S. of the division, you will find the
latter during a battle visiting these to see that they are operating
smoothly and whether more motor ambulances, stretchers, supplies or
other necessities are being provided.
At the same time you will find the D.M.S. of the army visiting his
special pets, the casualty clearing stations, and seeing that the
evacuation of the wounded by train is working smoothly.
The hospital trains are specially fitted up with beds, kitchens and
dispensaries, and with nurses and a medical officer in charge.
The hospital barges make the finest little hospitals that you could
desire. They are the ordinary flat-bottomed square-ended Dutch barges,
roofed in, and when the interior has been cleared out they form
elongated covered floating boxes. Skylights in the roof give a
splendid light, and the barges are wide enough to allow of two rows of
beds with an aisle down the middle. The medical officer's surgery and
bedroom are at one end of the barge, while the nurses' quarters are at
the other.
The barge is entered through the roof by a stairway, and the first
impression one gets on descending these is one of cosiness and
restfulness that is never forgotten. Whether the barge is moving or at
rest cannot be determined while one is inside, because the motion is
so easy through these sleepy placid canals. Usually only serious cases
that cannot stand the vibration and jar of a train journey are taken
by the water route.
In the British Army there are specialists of renown in medicine and
surgery who are supposed to supervise the medical and surgical work of
a certain given area. They travel about, find anything new that occurs
of interest, act as advisers, and hand on to other units the special
information or "stunts" that have been worked out or discovered at
home or in the field. The consulting surgeons are usually to be found
during a battle operating where there is the greatest need of skilled
surgery.
Besides the sanitary officer of each division there is a sanitary
officer for each army, and a chief sanitary officer for the whole
expeditionary force. These are all in touch with the sanitary adviser
at the base and the authorities in England. Since, under war
conditions, new developments are always taking place in this work, the
knowledge gained of practical value filters through to the army by
these channels as well as through the scientific journals.
Each army is provided in the field with one or more "advanced depots
of medical stores" which keep on hand and give out the drugs and
medical materials demanded by the various hospitals and medical units.
If, for example, a field ambulance wants a lot of iodine, absorbent
cotton, etc., the officer commanding sends an ambulance with an indent
signed by himself, and the officer in charge of the depot hands over
the material required.
There are other branches of the service, like the gas schools and
inland water service, which, though strictly not medical, are closely
akin to it.
It would be of little avail to speak of all the minute detail, of
which there is a tremendous amount in each and every one of these
offices and sections of the medical service. The methods of filing
correspondence and records alone is wonderful when one thinks of the
conditions and number of men involved, and comparatively few mistakes
are made. This appears the more remarkable when one has had numerous
experiences with the mistakes made in the offices in England where one
would think the systems would have been systematized long ago.
The medical service of the British Army in France is a marvel of
efficiency and one that the nation can well afford to be proud of.