« 이전계속 »
tant-surgeon who enters the service; and a very paltry prize it is for this great country to hold out to the Chief Medical Officer of its army.
The experiment of introducing the "civil element" into the medical department of our army, has heretofore been eminently unfortunate. Let us revert for a moment to the calamities of Walcheren. There was at that time a respectable old gentleman from civil life at the head of the department, the late iSir Lucas Pepys, who had, I believe, been a successful apothecary, or general practitioner at Weymouth, and had made himself acceptable to George III., when resident there. When called upon to proceed to Walcheren to give his assistance to the sick, he declined to move, sat still in Berkeley Street, and declared, in an official communication, that he could be of no use, and that he knew nothing of camp and contagious diseases but what he had learned from Sir John Pringle's book. To this, it was said by Cobbett, a great political writer of the day, with all the bitter irony of which he was so great a master, that the old gentleman had only one additional declaration to make, that he was unable to draw his salary.
On another occasion, when the opthalmia spread far and wide amongst the soldiery in this country, after the return of the army from Egypt, when the civil part of the population became alarmed for their eyesight, and when an enormous burden had been thrown upon the public by the number of men pensioned for blindness, a distinguished oculist from civil life, the late Sir William Adams, was placed at the head of a large and expensive opthalmic hospital in the Regent's Park; what was the result ?" It cannot," says Dr Vetch, "fail to surprise every impartial mind to observe, that even from the report of Sir William Adams himself, so far from effecting a national saving of L.60,000 per annum, which he had promised, by a reduction of the opthalmic pensioners, not one has been sufiieienlly benefited to admit of his pension being either reduced or taken away; and of six soldiers included in the report, all of them cases of opaque cornea, combined with the second stage of Egyptian opthalmia, not one has been rendered fit for duty, and all Iiave been added to the list of pensioners" It is, most assuredly, not with any idea of under-rating the attainments of my many eminent friends in civil life that I express myself thus strongly, but for the purpose of deprecating what I consider an injustice to the medical department of the army.
It is not, gentlemen, I repeat, from the want of able and intelligent men among the staff and regimental surgeons serving in the army of the Crimea, that that army has in any degree suffered. The want of that army, as of many others, has been in the inferior ranks, indeed in the very lowest grade of the attaches to the medical department—the want of a numerous and efficient hospital corps. In so far as some of the duties of such a corps have been zealously, kindly, and successfully discharged by Miss Nightingale and her female followers, I most willingly acknowledge the civil element; and in so far as these benevolent ladies have made up for the want of numerous orderlies, and thus spared the effective force of regiments, I am sure that every commanding officer will feel grateful to them.
Touching the alleged failures in the Crimea, " the medical department failed," says a public writer, " not because Surgeon Brown could not dress a wound, or Dr Jones prescribe for a case of dysentery, but because no adequate preparation had been made for tho reception of sick and wounded; because medical stores were sent to one port, while invalids were sent to another; and because purveyors were left to squabble for authority with inspectors, while patients were dying." And pray, whose fault was this? I have the best authority for saying, that had the resources and transport of the medical department been at its own disposal, much of the misery of that army would have been obviated.
One gentleman, I regret to think, has been most severely handled by the public press, not for any want of professional talent, but for apathy and want of interest, with which he was charged by the gallant officer commanding the troops. How far Dr Lawson's health may have been impaired, and his energies prostrated, by a protracted residence on the coast of Africa, for which (with a spirit most becoming in an army surgeon) he volunteered his services, 1 am unable to say. It is many years since I have seen him, but it is due to this gentleman, and to the memory of his excellent uncle, the late staff-surgeon Badenach, to say, that when a pupil of this class, some twenty years ago, a more steady, correct, industrious, intelligent, and promising student never sat on these benches. Of this you may judge by the following extract from the Edinburgh Medical and Surgical Journal for 1835 :—"On Monday, the 16th day of April, at the last meeting of the class of Military Surgery in the University of this city, in the presence of a considerable number of the professors of the medical faculty, and most of the medical officers of the Army, Navy, and East India Company's Service, resident here, the professor, after concluding the lecture, proceeded to announce the names of the gentlemen who had obtained prizes.
"By nearly the unanimous votes of the class, after a competition conducted in the presence of the Principal of the University, and numerous professional gentlemen, the individual selected as most distinguished by a knowledge of the subjects of military medicine and surgery, was Mr Robert Lawson, from Perthshire, in which decision the professor concurred, and Mr Lawson was accordingly recommended to the Director-General. We understand that he has since received the appointment so justly due to his merits."
It was, I think, upon that occasion that my predecessor Dr Thomson, in congratulating me on the appearance of my pupils, observed, that Sir James M'Grigor would require to extend his patronage—enough to show that Dr Lawson did not win his honours without a formidable competition.
There is only one other point, gentlemen, on which I should wish to be indulged with a few words; but as I have already trespassed upon your time, and have elsewhere expressed myself on the subject, I will endeavour to be brief. I have been very sorry to find anything saiil which is calculated to disparage our regimental hospitals, or any countenance given by gentlemen whose judgment I respect, to the opinion that they are only adapted to peaceable times, and that a forty years' peace has disqualified the medical officers of the army from expanding their views to the management of a general hospital.
This seems to me to be altogether a gratuitous assumption; and I would observe, that it was not in a time of peace, but of war, that the advantages of our regimental hospitals became fully developed. Hear what the late venerable Director-General says upon this subject 1 In a letter to his friend the late Dr Chisholm, written at the termination of the Peninsular war; after expressing his surprise at the extent and success of the regimental hospitals, Sir James M'Grigor goes on to say,—" However short a time a battalion or a corps rested in one place, a regimental hospital was established. It was frequently established in the face of an enemy, and nearly wTithiu reach of his guns. By making every corps constantly keep up an establishment for itself, we could prevent the general hospitals from being crowded. Much severe and acute disease was treated in its early and only curable stage, and no slight wounds or ailments were ever sent off from the regiments; by which means the effective force of the army was kept up, or perhaps increased by several thousand men, and this was effected by the joint exertions of the medical officers -who served in the Peninsula, the result of medical science, and their experience of soldiers, their habits, and their aptitude to particular diseases." Dr Chisholm adds for himself,—" In regimental hospitals, health and economy are united—in general hospitals, death aud a destructive waste of money. My own experience, which has been tolerably extensive, justifies this."
It were superfluous, and it were idle to make farther quotations upon this subject, because I believe that every experienced man conversant with these hospitals, who has committed his opinion to paper, lias expressed himself to the same effect. But on an occasion like the present, when the state of our hospitals has been so frequently and so unfavourably contrasted with those of our allies the 1 rench, it may not be out of place to refer to the sentiments of Baron Larrey. I had the pleasure of conducting that distinguished surgeon over the establishments of this city, both civil and military, now nearly thirty years ago, and I shall "not forget the admiration which he expressed with the state of the regimental hospital in Piersliill Barracks, then occupied bv the 7 th Hussars, and under the charge "* an assistant-surgeon, Dr Moffit. Not satisfied with this, he repeated his commendations to Sir James M'G rigor when he went to London, and wrote back to me to say that he nad done so, and that he had recommended to him the gentleman whom lie was pleased to term my protege. Dr Moffit's promotion took place soon after, and he considered it hastened by this kind recommendation of the Baron.
General hospitals, however, are indispensable on every extended scale of warfare, and I believe they never can be more advantageously conducted than by assimilating them as far as possible to our regimental establishments. General the hospital may be, general, as much as you will, in so far as the provisions, the cooking, the washing, the bedding, and the clothing of the sick are concerned, but let us, if possible, have their own surgeons to attend their own men. This may be carried to a great extent by classing the patients according to the divisions, brigades, or regiments to which they belong, having the medical staff of those divisions, brigades, or regiments to attend them, assisted by those non-commissioned officers and good conduct men of every regiment who may happen to be patients in the hospital, and who take an interest in their comrades, which strangers cannot be expected to do. This is a classification, as regards military hospitals, of equal, if not greater importance than some of those usually adopted on purely professional grounds; and the general hospital, whether under one or more roofs, thus becomes, as it were, a coiigeries of regimental hospitals.
I have already pointed out the difference between the province of the purveyor and the surgeon; and it is remarkable, that it is precisely at the point where the general and regimental hospitals meet, that the duties of a purveyor become paramount and indispensable, while the duties of a medical officer are in no degree changed, except in so far as he has to treat a disease which, having been acute in a regimental hospital, may probably have become chronic in a general one—a change for which surely every medical man is prepared. The purveying of a regimental hospital is for the most part a simple affair, and conducted successfully by the hospital sergeant, under the direction of the surgeon; b«t when serving in a general hospital, within the reach of daily or hourly communication with a purveyor, the surgeon is happily relieved of this.
So much are my old-lashioned notions in favour of the regimental principle, that I cannot help thinking it might with great advantage nave been extended farther in the recent operations in the Crimea. Had the large addition, so strenuously recommended by Mr Guthrie, been made to the regimental, instead of the general medical staff, I see nothing to have prevented the assistant-surgeons of* regiments, from having been detached in succession with the sick and wounded, just as the numbers of these increased, and as the number of fighting men diminished; to have succoured and assisted those men on their stormy passage across the Euxine, to have afterwards attended them
HBW SEKIKS.—.NO. VI. JUNE 1855. 3 P
iii the hospitals on the Bosphorus, and to have returned to their regiments with such of them as might again have become fit to take the field. I am here only referring to what has repeatedly happened to myself. I have, over and again, been detached from my regimea: with parties of sick, and it has happened to me to have served, more than once, in general and garrison hospitals, and to have sometinja had a portion of one of them given up to nie for a regimental establishment, according to an arrangement which may, I believe, at this moment, be seen in the King's Infirmary, in the Phoenix Park, a: Dublin, or at least was to be seen when I last visited that establiihment some few years ago.
I know of no duty of a staff" assistant-surgeon to which a regimental assistant is not competent, but I do not hold that the converse of this proposition is equally true. I have the highest opinion of that "esprit de corps," which is fostered by regimental intercourse, and those " ties of regimental discipline," which, as Dr Millingen says, "constitute the superiority of battalion hospitals." I know -well how much that knowledge of character acquired by a regimental surgeon—that interest on the one hand, and that confidence on the other—engendered between him and his patients, contributes to the successful treatment of disease. I have, myself, been sent for to amputate the limb of a soldier, lying in a garrison hospital, a few miles distant from the spot where I happened to be encamped. This young man, finding that his limb must come oft', asked as a special favour that his own surgeon might be asked to operate. This the garrison surgeon kindly consented to, and the young man speedily recovered.
The successful discharge of regimental duties were always looked upon in my day, and, I believe, very justly looked upon, as the best preparation for the duties of the staff, whether military or medical. Where, I should be glad to know, except in the exercise of regimental duties, were such men as Jackson, M'Grigor, Hennen, Guthrie, French, Franklin, and many others prepared for those general duties which they have so successfully discharged in all quarters of the world? Of the last two named gentlemen, the former went to China as surgeon of the 49th regiment, and was placed at the head of the department as the senior medical officer of the Queen's troops employed in the Chinese War. The other was Inspector of Hospitals to the Queen's troops at Chillianwallah and Goojerat, those conflicts in the Punjaub which have given peace to that part of India for many years past. No ! Gentlemen, I will not believe that the surgeons of the army are unequal to the conduct of general hospitals.