CHAPTER V.

SERVICE ON BOARD SHIP.'

SERVICE on board ship must be divided into three sections, corresponding to three different kinds of service.

1. Transport ships, for the conveyance of healthy soldiers, their wives and children, from place to place, or for conveying small parties of troops in charge of convicts.

2. Transports for conveyance of sick from an army in the field to an hospital in rear, or from a foreign station to a sanitarium, or home. Although the term is a little odd, it is convenient to call these ships SickTransports.

3. Hospital ships, intended for the reception and treatment of the sick.

SECTION I.

TRANSPORTS FOR HEALTHY TROOPS.'

The use of Government transports has very much altered the duty of medical officers on board. The transports are really men-of-war, i.e., officered by the Royal Navy and under naval regulations. The medical officer of troops has therefore nothing to do with the vessel and its arrangements. If hired transports are used, the "Queen's Regulations" (1881) (section 17, Movement of Troops by Sea), and the "Medical Regulations " (Part I., section iii., sub-section iii.; Part II, section vi., sub-section x.; Part V., section vii.), have to be carried out.

SECTION II

TRANSPORTS FOR SICK TROOPS.

No specific regulations are laid down with respect to these hired ships, but it would be very desirable to have some set rules with respect to space, diet, and fittings. Invalids are now carried from India and the Colonies in Government transports; occasionally hired transports are used. At

1 See Rattray's paper read to the Medico-Chirurgical Society in 1872; also the last edition of this work; and Naval Hygiene, by Professor Macdonald, R. N., M.D., F.R.S. (Smith, Elder & Co.), 1881.

* The following note is given in the Queen's Regulations, 1881, p. 372: "A TroopShip is one of Her Majesty's ships commissioned as a troop-ship. A Transport is a ship wholly engaged for the Government service on monthly hire, or a ship wholly engaged by the Government to execute a special troop service, though not hired by the month. A Troop Freight Ship is a ship in which conveyance is engaged by Government for troops, but which is not wholly at the disposal of the Government."

present the diet of invalids on board the hired transports is not good. In respect of fittings, the use of swinging cots for feeble men and wellarranged closets for dysenteric cases are very important. So also with the cooking; the coarse ship cooking is a great trial to many patients. If there is need of Government transports for healthy men, the necessity is still greater for sick men.

As far as possible, the sick should be treated on deck in fine weather, a good awning and a comfortable part of the deck being appropriated to them. I believe that it would be a good plan not to send home officers and sick men in the same ship, but to have officers' ships, so as to give up the poop to the men in the ships which carried them. This division will be a gain to both.

In time of war, sick-transports are largely used to carry troops to hospitals in the rear. For this purpose good roomy steamers must be chosen. For economy's sake, they will generally be large, and probably with two decks; they should never have more, and indeed a single deck is better. But if with two decks, each space should be separately ventilated by tubes, so as, as far as possible, to prevent passage of foul air from the lower to the upper deck. All the worst cases should be on the upper deck, especially surgical cases.

The decks of these vessels should be as clear as possible, so that men can be treated on deck. An apparatus should be arranged for hoisting men on deck from below.

It has been proposed to fit these ships with iron bedsteads, and no doubt this gives the men more space; but a better plan still would probably be to have short iron rods, to which every cot could be suspended. The sick men might be carried in their cots on board, and again removed. If the rods are made about 14 inches high, and bent in at the top so as to form a hook, a cot is hung easily, and will swing. There is space enough below to put a close-stool or pan under the man without stirring him, if a flap is left open in the canvas, and a hole left in the thin mattress.

Fixed berths are not so good, but some must be provided. Some cots can swing from the top, and some men can be in hammocks. Probably every sick-transport should have all these, viz., iron bedsteads at some points fastened to the deck, iron standards for swinging cots, cots swinging from the roof, low berths, and hammocks.

In these sick-transports the kits and clothes must be stowed away; and as they are often very dirty and offensive, and sometimes carry the poison of typhus and other diseases, the place where they are put should be constantly fumigated with nitrous and sulphurous acid alternately. Robert Jackson mentions that dirty clothes and bedding may be soon washed sweet by mixing oatmeal with salt water.

Directly a sick-transport has landed the sick, the whole place should be thoroughly washed and scraped, then the walls and ceiling should be limewashed, and the between-decks constantly fumigated till the very moment when fresh sick embark.

SECTION III.

HOSPITAL SHIPS.

These are ships intended for the reception and treatment of the sickfloating hospitals, in short. Whenever operations are undertaken along a sea-board, and especially when a force is moving, and places for fixed hos

pitals cannot be assigned, they are indispensable. They at once relieve the army from a very heavy encumbrance, and, by prompt attendance which can be given to the sick, save many lives. They should always be organized at the commencement of a campaign. In the Abyssinian war three hospital ships were used. Their fitting out was carefully superintended by Deputy Inspector-General Dr. Massy, and appears to have answered admirably. A full account of one of these ships (Queen of the South) was given by the late Staff-Surgeon Charteris, to which reference may be made. The ventilation, as shown by the amount of carbonic acid (0.708 per 1,000 volumes), was very good. The superficial space between decks per man was on the night of the experiment 154 feet, and the cubic space no less than 1,076. During the Ashanti war (1873-74) the line-of-battle ship Victor Emanuel was used as an hospital ship, and was most successful. A very full and detailed account of it is given by the late Brigade-Surgeon T. M. Bleckley, C.B., in medical charge. The floor-space per head was generally about 50 square feet, and the cubic space about 480, although it was originally intended to be less. Hospital ships were also used during the Egyptian campaign of 1882.

However convenient, and indeed necessary, they are, it must be clearly understood that they are not equal to an hospital on shore. It is impossible to ventilate and clean them thoroughly. The space is small between decks. The wood gets impregnated with effluvia, and even sometimes the bilge is contaminated. Dr. Becher, late pathologist in China, stated that even in the very best of the hospitals used there, it was quite clear that in every wound there was evidence of a slight gangrenous tendency. In fact, it is perhaps impossible to prevent this, except by the freest ventilation and the most vigorous antiseptic treatment.

The principle of separation should be carried out in these ships-one ship for wounded men, another for fevers, a third for mixed cases; or if this cannot be done, separate decks should be assigned for wounded men and fever cases. In fine weather the sick should be treated on deck under awnings. The between-decks must be thoroughly ventilated, and all measures of fumigation, frequent lime-washing, etc., must be constantly employed. Charcoal, also, in substance should be largely used. Warming by stoves must be used in damp and cold weather, and, if so, advantage should be taken of this source of heat, and of all lights, to improve ventilation.

Ships of one deck are better than two; but as they will hold a very small number of sick, two decks are commonly used. But not more than two decks should be used; and if there be a third or orlop deck, it should be kept for stores. Sometimes, if there are two decks, the upper deck is used for officers and the lower for troops, but the reverse arrangement should be adopted.

The ventilation of the between-decks, in addition to Edmond's plan, should be carried on by tubes, which, if the central shaft is acting, will be all inlets, and can be so arranged as to cause good distribution of the air.

The fittings of an hospital ship should be as few and simple as possible, and invariably of iron. Tables should be small, and on thin iron legs. Swinging cots are indispensable for wounded men, and the appliances for the receiving and removing the excreta of dysenteric and febrile patients must be carefully attended to. Berths should not be of wood, but of iron bars, which are much more easily laid bare and cleaned.

The supply of distilled drinking-water should be as large as possible,

1 1 Army Medical Reports, vol. xv., p. 260.

and a good distilling apparatus should be on board, whether the vessel be a steamer or not.

The laundry arrangements are most important, and it would be a good plan, on a large expedition, to have a small ship converted entirely into a laundry. It would not only wash for the sick, but for the healthy men also. So also a separate ship for a bakery is an important point, so as to have no baking on board the hospital ship.

On board the hospital ship there should be constant fumigation; limewashing, whenever any part of the hospital can be cleaned for a day or two, and, in fact, every other precaution taken which can be thought of to make the floating hospital equally clean, dry, well aërated and pure as an hospital on shore.

On board hospital ships it is often easy to arrange for sea-bathing and douching; it should never be forgotten what important curative means these are.

In case pyæmia and erysipelas, or hospital gangrene occur, the cases must be treated on deck, no matter how bad the weather may be. Good awnings to protect from wind and rain can be put up.

If cows or goats are kept on board to supply milk, their stalls must be kept thoroughly cleaned. But generally it is better to obtain milk from the shore.

CHAPTER VI.

THE trade of the soldier is war.

WAR.

For war he is selected, maintained, and taught. As a force at the command of a government, the army is also an agent for maintaining public order; but this is a minor object, and only occasionally called for, when the civil power is incompetent.

In theory, an army should be so trained for war as to be ready to take the field at literally a moment's notice. The various parts composing it should be so organized that, almost as quickly as the telegram flies, they can be brought together at any point, prompt to commence those combined actions by which a body of men are moved, fed, clothed, kept supplied with munitions of war, maintained in health, or cured if sick, and ready to undertake all the engineering, mechanical, and strategical and tactical movements which constitute the art of war.

That an organization so perfect shall be carried out, it is necessary that all its parts shall be equally efficient; if one fails, the whole machine breaks down. The strength of a chain is the strength of its weakest link, and this may be said with equal truth of an army. Commissariat, transport, medical, and engineering appliances are as essential as the arts of tactics and strategy. It is a narrow and a dangerous view which sees in war merely the movements of the soldier, without recognizing the less seen agencies which insure that the soldier shall be armed, fed, clothed, healthy, and vigorous.

During peace the soldier is trained for war. What is meant by training for war? Not merely that the soldier shall be taught to use his weapons with effect, and to act his part in that machine, where something of mechanical accuracy is imprinted on human beings, but that he shall also know how to meet and individually cope with the various conditions of war, which differ so much from those of peace.

It is in the nature of war to reinduce a sort of barbarism. The arts and appliances of peace, which tend, almost without our care, to shelter, and clothe, and feed us, disappear. The man reverts in part to his pristine condition, and often must minister as he best may to his own wants. No doubt the State will aid him in this; but it is impossible to do so as completely as in peace. Often, indeed, an army in war has maintained itself in complete independence of its base of supplies, and in almost every campaign there is more or less of this independence of action.

In peace, the soldier, as far as clothing, feeding, shelter, and cleanliness are concerned, is almost reduced to the condition of a passive agent. Everything is done for him, and all the appliances of science are brought into play to save labor and to lessen cost. Is this the proper plan? Looking to the conditions of war, ought not a soldier to be considered in the light of an emigrant, who may suddenly be called upon to quit the appliances