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A slight increase to the strength of the medical staff would enable the Director-General to carry out this arrangement at a very trilling cost to the public; and it is surely not too much to expect that an act of such obvious justice should at once be sanctioned by the Minister of State for War. Such an increase is indeed the only suggestion for the improvement of the department which was made to the Committee by the Adjutant-General.
Promotion.—The next point of importance to which we shall refer is comprised in the following paragraph in the Surgeons' Memorial : “ With regard to promotion, we trust your Lordship will not consider us presumptuous if we take the liberty of pointing out to you the necessity and expediency of some fixed principles being established whereby it should be regulated.” In his observations on this paragraph, and also in a letter to Dr. Hall, dated the 17th of August, 1855 (p. 298), Dr. Smith asserts that the promotion is conducted on a definite plan; he says, “A fixed principle is, as far as practicable, observed; seniority is the general rule, and is only inoperative when the interest of the service, or of the department, appear to render another practice necessary;" and he proceeds to detail what these circumstances are. This statement, however, of the general principle on which promotions are said to be recommended, does not accord with that subsequently given in his evidence before the Committee. For in his examination on the 1st of May, 1856, he was asked,
« Wliat is the general rule in recommending an assistant-surgeon to be made a full surgeon ?- A. The senior is promoted invariably, unless there is something in the senior that renders it improper that he should be advanced.
"Q. 109. Have you observed that rule also in other cases of promotion in the higher ranks 1 4. No; the established rule with regard to them is selection."
· So that it appears that in the case then under consideration-for it was with reference to the Surgeons' Memorial that the first statement was made-the "fixed principle" of promotion was the very reverse of that which he stated for Lord Panmure's information. In a subsequent examination, Dr. Smith detailed at some lengtlı the mode in which promotions had been made since his accession to office, and stated that he had “exercised to a very small degree the principle of selection;" and that only in very strong cases. But it also appeared that the regulations on the subject of promotion were among the leges non scriptæ of the department; that they were contained chiefly in letters extending over forty years, and that they did not exist in any codified form. This is to be regretted, for so long as they remain undeclared, officers will continue to think themselves subject to the caprice of the head of the departmient, even when they are treated in accordance with rules laid down by the higher authorities for his guidance.' The Director General would act wisely if he were to have the rules drawn out clearly, and promulgated for the information of all whom it may concern.
But the question of the principle on which promotions are made, brought under the consideration of the Committee another subject of great importance to the medical officers, although unnoticed in the Memorial and in Dr. Smith's Observations. It is that of
Confidential Reports.- It appears that the Director-General “ Receives yearly, sometimes oftener, from the principal medical officers of large hospitals or commands, reports in reference to the medical officers who have done duty under them, stating those that had been efficient and those that bad not; those that had been indolent and those that had been active; also the qualification of all in every other respect”-and that he has been in the habit of making selections for promotion in accordance with the tenor of these reports. (Q. 110.)
But these confidential reports are not communicated to the officers against whom they operate so injuriously, and an opportunity is not afforded them of explaining matters which may-very probably undesignedly-have been misrepresented to the Director-General. It is true that Dr. Smith says
"If an officer was to complain to me that he was suffering seriously in consequence of some reason or other, in a way that he did not think he deserved to suffer, and if he claimed consideration or advancement, I would consider it then my duty to tell him why he was suffering. But I do not make it a rule to communicate the confidential reports.”
But there are many officers who would submit to what they deemed an injustice without remonstrating, and who would probably attribute to personal feeling a course of conduct arising out of these reports. When an officer is not afforded an opportunity of refuting charges thus brought against him, the confidential reports, if incorrect, become anonymous slanders. This is not the case with the reports made by the inspecting general officers to the Commander-in-Chief. Lord De Ros states that in every instance in which an officer is reported upon, he is informed of it, and that no charge can be brought against an officer in the Inspecting-General's report which he has not an opportunity of answering. The Adjutant-General says:
“It is the invariable practice, when any unfavourable report is made of any officer, that that report is brought to the officer's notice through his commanding officer.” (Q. 3270.) - And H.R.H. the Duke of Cambridge observes:
“I think that if a man is reported against for such neglect of duty as would bar his promotion, he ought to be informed of it; I think that no man ought to be put in that position without being informed of it.” (Q. 3678.)
We trust that after the very strong expression of opinion against the existing practice, the designation “confidential” will no longer be deemed synonymous with “secret” reports. It is quite incomprehensible how such a system could ever have been tolerated.
Service in the Field.—The surgeons, in their Memorial, “Suggest that active employment in the field should reckon as equivalent to three times the amount of ordinary service, and that colonial service should also receive some consideration above that passed in Great Britain."
But Dr. Smith objects to this, and as it appears to us with much justice, that service in some of our colonies is more destructive to health and more fatal than many campaigns. Again, if colonial service were to receive the consideration thus recommended, it would be necessary to establish a sliding-scale according to the morbific character of the command. But Dr. Smith observes truly:
«That in the army, officers are compelled to serve where they are ordered, therefore the accident of some being on service in the colonies or in England, whilst others are in the field, is not the result of any act of their own, and therefore ought not to operate to their prejudice, the more especially because there are few of them who would not, if they had their choice, be with the army in the Crimea.”
Among the subjects inquired into by the Committee, was that of the
Appointment of Dispensers ; and from the time and care bestowed upon this portion of the investigation, it was evidently deemed a question of considerable importance. By the regulations of the army, medical officers are forbidden to employ the hospital sergeants or orderlies to compound the medicines, and are required to certify in their reports that they have not done so. A serious practical evil results from this : during periods of excessive sickness, or when there are many serious cases under treatment in hospital, the surgeon is obliged to devote a considerable portion of his time to this duty, when he might be more profitably employed in the wards ; and from this, of course, the patients suffer. It has also the natural tendency to lead the surgeon to prescribe remedies which cause little trouble in compounding, in preference to those which he might otherwise select. The former of these evils was severely felt in the Crimea, and with a view to obviate it, Dr. Smith recommended the appointment of dispensers, with the rank of ensign, and the pay of 78. 6d. per diem. They were mostly young men who had been employed for some time in chemists' shops, and passed an examination as to their fitness before a Board of Medical Officers. Such of them as were appointed to regiments were gazetted, and received commissions, while those employed on the staff were merely warrant officers. The plan as carried out seems to have met with general condemnation, both from the military and medical officers, Dr. Smith alone, of all the witnesses, expressing a favourable opinion of it. But even he did not approve of them being gazetted as officers, though it does not appear by whom that measure was adopted, contrary to his opinion; it certainly could not be any one practically conversant with military matters. The objections to these dispensers were, that they were not taken from that class of society from which officers are usually obtained ; that from their previous habits, education, and position, they were not suited to take a position among the officers, and that, from the want of qualification, they could not hope for any further advancement in the profession. There cannot be a question that it must prove injurious to the department to create in it a rank having a low educational, professional, and civil status, and the members of which are without the greatest incentive to exertion—hope. The Guards are exempt from the operation of the general rule above quoted, and have a non-commissioned officer attached to each of their hospitals, whose sole duty appears to be to compound and dispense. It seemed to be the general feeling of the witnesses that this system might be extended to the Line, and that a sergeant, receiving a moderate additional pay, would be much more suitable for duties of this nature than a commissioned officer. If we may judge from the very creditable appear. ance made by the Guards' sergeants when examined before the Committee, they are a class of men well qualified for such situations. We trust that the suggestions on this subject made to the Committee will receive due consideration, and that a superior class of non-commissioned officers will be created, fit to be intrusted with, and suitably remanerated for, the discharge of this important duty.
Another subject incidentally noticed by the Committee was the organization of
The Medical Staf Corps.—This body was raised to supply a want greatly felt in the early part of the war-that of hospital sergeants and servants, and if properly carried out would be a most valuable addition to the department. But, in the first instance at least, it seemed to share in the mismanagement which disgraced our military system; for Captain Bunbury, the officer appointed to raise it, says that he had no written orders to guide him ; that his instructions were “aerely to organize, clothe, and equip the corps as recruits came in." The result was, that out of nine hundred and ninety-three men enlisted, five hundred and twenty-four were found ineligible “ because they could not read and write, and because of their general appear. ance.” Dr. Mackenzie, who had to examine some of these recruits at Manchester, says:
"I was not informed whether they were required to be able to read or write, or whether they were to be physically more or less fit for the service than other men. When I asked them for what regiment they were intended, and they told me it was for the Medical Staff Corps, I looked up in amazement, never having heard of it before."
Sir B. Hawes, the Deputy Secretary-at-War, admitted that,
“At first there was some misunderstanding, but latterly they have been required to read and write well, and to present general testimonials of character.”
He did not inform the Committee who was to blame for this “mis. understanding," but we think it fair to state that Dr. Smith repudiated all responsibility in the matter.
The suggestions of the Duke of Cambridge as to the constitution of the corps and the mode of recruiting it, are those of a practical man acquainted with the subject on which he speaks, and deserve the serious attention of the authorities who are responsible for this branch of the service. The importance of training an efficient body of intelligent hospital-sergeants and dispensers, and of steady, reliable orderlies, cannot be over estimated, whether as regards the welfare of the sick soldier or the comfort and usefulness of the medical officer.
The preceding appear to be the chief deficiencies and grievances in the medical department of the army, and we trust the authorities. military and medical, will lose no time in having them removed. It is gratifying to find that, notwithstanding the injustice with which the medical officers have so long been treated, they have proved themselves, according to the testimony of the highest military authorities who were examined before the Committee, to be zealous, efficient, and unflinching in the discharge of their duties, and humane and kind to the soldier. Lord De Ros, who was Quartermaster-General in Bulgaria, says
“From what I saw of the department when illness broke out in the fearful manner it did at Varna, I was strongly impressed with the idea that it was impossible for any body of men to do their duty better, or with more zeal and kindness.” (Q. 2559.)
Sir Richard Airey, who held the same important appointment in the Crimea, corroborates this statement :
“I do not think it is possible that there could have been a more energetic, anxious, or active class of men in the world than they were.” (Q. 4392.)
And his Royal Highness the Duke of Cambridge, in confirming the testimony which he had formerly given before the Sebastopol Committee as to “the great exertions and philanthropy of the medical officers generally," again observes
“I had every reason to be well satisfied with the great exertions of the medical officers.” (2. 3644.)
In Colonel Tulloch's review of the proceedings and report of the Chelsea Board, there is no direct allusion to the army medical department. Sir John Hall appears to have deemed it more prudent not to appeal to that tribunal against the animadversions contained in the report of the Commissioners. He declined the opportunity offered him of explaining the charges brought against him, and thus virtually admitted the justice of the censure passed upon him by them. Under these circumstances, we should not have considered it necessary to notice this book, but in it Colonel Tulloch has been permitted to publish “ The summary of information relative to the sickness, mortality, and prevailing diseases among the troops serving in the Crimea,” which Lord Panmure decided, when the original report was presented to him, “ was not comprised in the instructions of the Commissioners." The information now published has been so ably condensed already, that to give a correct idea of it would merely be to reprint the whole; we shall therefore only notice a few of the general results which corroborate in a most striking manner the conclusions at which we arrived in reference to the causes of the excessive mortality in the Crimea, from a careful study of the evidence taken before the Sebastopol Committee and the Crimean Commissioners.*
The total mortality by disease in the army in the Crimea during the seven months, from the 1st of October, 1854, to the 30th of April, 1855, amounted to 35 per cent., including the deaths at Scutari and in the hospitals on the Bosphorus. The loss in the ill-fated Walcheren expedition amounted only to 104 per cent. in six months, and during the Peninsular war it did not exceed 12 per cent. for a whole year. The proportion of deaths varied greatly in the different arms of the service in the Crimea. Thus, in the Cavalry it was 15 per cent., in the Ordnance 18, in the regiments of the Line it amounted to 39 per cent. ; while in the Naval Brigade, “which took a very pro
• See British and Foreign Medico-Chirurgical Review, Oct. 1855, and July, 1856.