Part First.

ORIGINAL COMMUNICATIONS.

ARTICLE I.- On the Army Medical Department and the Introduction of the "Civil Element" into Military Hospitals. By Sir GEORGE BALLINGALL, Regius Professor of Military Surgery in the University of Edinburgh.

(From an Introductory Lecture to the Course of Military Surgery, May 1855.) It is not with military men that the difficulties of the medical department have heretofore generally arisen, but with the underlings of those numerous collateral offices which have so long been permitted to impair the energies and exhaust the strength of a War Department in this country. A man who will not hesitate to storm a breach, or to head a charge of cavalry, such as that of the light brigade at Balaklava, will think twice before he opposes the opinions, or impedes the operations of an intelligent and experienced surgeon. Nay, such a man will be the very first to listen to any respectful and reasonable suggestion touching the health of his men. If such things as I have cursorily noticed can be done by a regimental medical officer,-who, if he knows his duty, and chooses to do it, may be a very independent man,-if such things can be done by a regimental surgeon, what ought to be the influence of a man of energy, experience, and decision, at the head of the depart

ment?

The trammelling of the medical department has been a growing evil, although spoken of by many as something new. The limited powers and want of independent action has been, more or less, a standing and a just cause of complaint ever since I knew anything of the service; but in spite of this, we have often had the duties of the department carried on with success, and we have had men amongst us, more than one, who, if an independent action was not conceded to them, did not hesitate to take it.

Amongst these, I am tempted to mention a name which will probably be new to most of you-the name of my late friend, Mr Young-and I do this the more willingly, because he is little beholden to posthumous fame, in consequence of never, so far as I know, having written anything for publication. This gentleman, in

NEW SERIES.-NO. VI. JUNE 1855.

30

his regimental days, was a predecessor of mine in the Royals, where his name was long held in respect, and he spent the evening of a long and laborious life in this neighbourhood, at Rosetta, near Peebles, where he had built himself a residence, and borrowed its name from the scene of his former labours in Egypt. He was at the head of the medical staff upon two memorable occasions, and it was said to his praise, that "the worst calamities of war had no place either amidst the swamps of Holland, or on the burning sands of Egypt." And it was said some four-and-fifty years ago, with reference to his conduct, and to the point of independent action, that, "In what concerns the health of an army, the praise or blame must, peculiarly and distinctly, belong to the medical superintendent; because the events then, whether prosperous or adverse, must depend upon causes of which professional skill alone is competent to takę cognisance. The hospitals, of course, must be just as much under the Inspector-General as the arrangements of the field are under the Commander-in-Chief, and consequently any peculiarity of success in the recovery of the sick and wounded is as much to the appropriate praise of the former, as the wise array of a battle or a siege is to the distinct honour of the latter."

Mr Young, gentleman, was a man of the stamp of Larrey, to whom he was well known in Egypt, and who inquired most kindly for him, when he visited this city. He was a man who saw no obstacles in his way, who stuck at nothing for the benefit of the sick, and who suffered no inroad on the rights of his department. When chief of the staff in the West Indies, a young doctor was sent out to him as physician to the forces, with the king's commission and an Oxford or Cambridge degree in his pocket, the only ones then qualifying for that rank. Mr Young declined to receive him, telling him that he could not allow those gentlemen who had been toiling under him as staff and regimental surgeons to be superseded by one who had never before seen a sick soldier. The young man, seeing that there was no room for him in that quarter, requested the Inspector to give him an order on the paymaster for some money, and on the agent of transports, to carry him home. The reply was, "I will not acknowledge you by any official act whatever." But, said Mr Young, I happen to have some money at my credit in the paymaster's books, and whatever you want I will most willingly give you.

The gentleman found his way back to England, and Mr Young soon after followed. He was ordered to repair to the Medical Board, and there he found the physician-general and the surgeongeneral (neither of whom had any previous service to lean upon), in great indignation at this insult to their authority, and the former remarked upon Mr Young's courtesy to the physicians to the forces, to which he calmly replied, that if the thing was to do over again he would just do as he had done. The surgeon-general then showed his temper, and observed that they had not made up their minds

whether they would not bring the whole proceeding before a courtmartial, to which Mr Young, taking up his hat, and making his bow, said, "the sooner the better." The court-martial, however, was no more heard of; they knew that he had the feeling of the service with him, and that he had Sir Ralph Abercromby at his back. I appealed for the truth of this anecdote to Mr Young himself, stating it to him as I had heard it, and as I now repeat it to you. He quietly observed that it "was very near the truth."

This leads me naturally to say a word on the introduction of the "civil element" into the military hospitals. It will not be supposed that I, who lived and practised so long in harmony with my professional brethren in this distinguished seat of medical erudition-who have now been so long an atom in this "civil element"-who, amongst those who have closed a brilliant career, have been often in consultation with such men as Gregory, Abercrombie, and Liston -who have had the honour to rank amongst my colleagues in the University, such men as Thomson and Charles Bell, will be found wanting in respect for the civil branch of my profession. The civil members of the profession have evinced a most generous spirit in the way in which they have espoused the cause of the assistantsurgeons of the Navy; and I am sure they will sympathise with those men who have been spending toilsome days and sleepless nights under canvas in the Crimea, and are now made the scapegoats for errors committed at home. It grieves me to think that these men should find themselves, at the close of a campaign, supplanted by others who have not borne the "burden and heat of the day." Could I believe that this was for the good of the public service, I would speedily be reconciled to it. But is it to be supposed, that men who have, like myself, been accustomed to see their hospitals broken up soon after midnight, to make a march of twelve or fifteen miles, and to have their hospitals again in operation by the time they sat down to breakfast, and this from day to day for weeks in succession-is it, I say, to be supposed that men conversant with such duties as this, are less competent to the organisation of new hospitals than those who have passed perhaps an hour a day in the simple duty of prescription?

I have all along maintained that there never was a want in the army of the Crimea of men equal to the higher duties of the department; but instead of seeing those men promoted to a higher rank, which they have so well earned, and appointed to what would have been to many of them an easy duty, they are superseded by men who, whatever may be their merits in other respects-and these I have no desire to question-have never hitherto had an opportunity of giving an opinion on the position, construction, or economy of an hospital-and all this at an increased expense to the nation. How far this is calculated to attract talent to the public service, to encourage merit, or to benefit the sick soldier, it is for the Government to judge.

It is quite clear that a sufficient number of hands (to use a seaman's phrase) could not be spared from the Crimea, to man these auxiliary hospitals; but, with the diminished numbers and improved health of our army in that quarter, occasion might have been found for the promotion of some half-dozen of staff-surgeons, to be placed at the head of them; and I make no doubt that many of the young gentlemen who have volunteered for the duties of those hospitals would have preferred serving under men of rank, standing, and experience in the army. What is it, I should be glad to know, that is required from the civil hospitals? is it those limited powers often imposed upon physicians and surgeons by a close-fisted treasurer? is it those delays and impediments to improvement occurring from the necessity of a reference to the governors? it is that vexatious interference on professional points sometimes exercised by a philosophie manager? or is it that divided and imperfect responsibility under which medical men have sometimes been enabled to shelter themselves when decidedly in the wrong?

The military hospitals, in my younger days, were looked to as patterns for imitation in the organisation of similar establishments for the purposes of civil life. I have now had some experience of both, and I say advisedly, that although the military hospitals are not in all respects what they might be, there is, in these hospitals, much of that arrangement, promptitude, and self-reliance, which ought to characterise all military proceedings. The quantity of superfluous writing in the medical department has, I am glad to see, been well exposed by my friend Dr Dumbreck, in his evidence before Mr Roebuck's Committee, and I fear that this department has to answer for a large share of the L.70,000 worth of stationery said to have been sent out with the army of the Crimea.

The absurd system of checks and counterchecks, so forcibly exposed by the late Secretary-at-War, would still seem to be in full operation. Of this I recollect a very ludicrous instance, and was in some degree a party to it, when a very young man. The hospital expenditure account was "returned for correction," and the surgeon, the hospital-sergeant, and myself, set our wits to work, and mustered all our joint stock of arithmetic to discover the error, but being unsuccessful, the account was sent back to the Medical Board, and was twice again "returned for correction." As if to make the thing more ridiculous, an orderly dragoon was kept galloping backwards and forwards between the head-quarters of the district and the village where we were quartered, with this precious despatch, and the mighty error turned out to be "an ounce of oatmeal overcharged." Had the clerks in the Medical Board, who at that time checked the returns, condescended to mark, by a cross on the margin or otherwise, where the error lay, it would have saved a considerable loss of time and temper, to say nothing of the wear and tear of man and horse.

This, however, chiefly concerns the public; but there are some

cases in which I fear the medical department has assisted in forging its own fetters. I should be glad to know what has become of all those portly folios which have been accumulating in our regimental hospitals for a long series of years, at a great expense to the nation, great labour to the surgeons, and little edification to the profession. It is no doubt an object of great importance, particularly when men are brought forward to be invalided, to have an authentic record to refer to, showing how often a man has been in hospital, and for what particular complaints; but surely all this might be accomplished without allotting a page or two of those huge folios to every man admitted, compelling the surgeon to spin his brains to give a graphic description of a sprained wrist, or an ulcerated leg, or to detail with equal prolixity the case of one man with a virulent gonorrhoea, and another with a malignant typhus fever.

I know no good that comes of this compulsory writing; but there is another description of writing which I should wish to see encouraged. I know not at this precise moment what are the regulations, or what is the practice of the French army, but I know, that from the medical officers of that army have emanated more than sixty volumes of the "Recueil de Mémoires de Médecine de Chirurgie et de Pharmacie Militaires." This published under the authority, and at the expense of the Government, and containing many valuable papers on subjects all important to the health of the troops. In this, I think we would do well to imitate them. In addition to all other professional competitions open to the military surgeons as well as to others, I should like to see a competition instituted within the department itself. Who will show himself most conversant with the diseases of soldiers and seamen, and with those injuries to which they are exposed in the battle-field, and on the ship's deck? Who will give us the best papers on the medical topography of our many foreign stations, and on the best sites for camps, cantonments, barracks, and hospitals at home and abroad? Who, in short, will evince the most perfect knowledge of all the juvantia et laedentia of a military life? A selection of such papers by an impartial committee, and published by the Government, would give encouragement to the department, and health to the

army.

With reference once more to this "civil element," for which we are indebted to his Grace the Duke of Newcastle, I would observe, that the expression is somewhat indefinite; and as we are not told how far it is to be carried in the re-organisation of the medical department, I would say that if this element must be introduced into the department, it should be at the bottom, not at the top of the tree. I wonder what civil element actuated Larrey when he killed the spare horses of the officers to make soup for his men. This you will allow was a most uncivil proceeding; but for this, Napoleon made him, on the instant, a Baron of the Empire. The highest prize in the medical department ought to be accessible to the youngest assis