NAVY, ARMY, AND AMBULANCE.

391 substitution in its stead of a system of insurance for the payment of fees. Mr. GEORGE JACKSON (Plymouth) supported the principle Otherwise a large class of of small weekly payments. patients would resort to the Poor-law medical officers. He, however, objected to the Eastbourne Medical Provident Association doing other men’s work by vaccinating

In its report the enter the service. Idoubtless mittee expressed " much satisfaction in the

status

gratuitously. Mr. R. H. WOLSTENHOLME (Manchester) said that he would support the first part of the motion only. Contract work led to hospital abuse, but there were many other alternatives. In response to Dr. Alfred Cox’s request for figures he submitted the following in regard to a society with which he was acquainted : Visits in the course of one year, 8272 ; consultations, 13,673 ; medicines dispensed, 16,106 ; candidates examined, 257 ; and births attended, 44. Total payment received for all this work, £314 18s. He did not think that medical men should go about establishing cheap dispensaries for the people. How could they protest against contract work when they were living by it? The Eastbourne method worked out, he was told, at 6d. a visit and 6d. the medicine. They had " sixpenny doctors" in Manchester, and he did not like them ; but, as they charged Is. a bottle for medicine they got Is. 6d., and this was better than the Eastbourne average. There were, he noticed, at Eastbourne and elsewhere enticing lists of high fees for surgical operations, but this was only a snare and delusion, for in such cases the patients all went to the hospital. Mr. E. H. T. NASH (Accrington) qualified club practice as immoral, because it led to the neglect of surgical and important cases which the club medical officer passed on to the hospital. In the North the collecting system prevailed. Patients paid fall fees at the rate of 2s. a fortnight till the bill was settled. Dr. S. CRAWSHAW (Ashton-under-Lyne) did not believe that private patients would pay if they resorted to the collecting system. They would continue to consult their medical attendant till he pressed them too severely and then they would go to someone else. There would be many bad debts. The contract work was the best that could be done with this class of people. The PRESIDENT now thought the time had come to close the discussion. To sum up, he agreed with Mr. Wolstenholme, for he found that at Oldham there were no clubs or contract work. The practitioners there had agreed among themselves not to accept any contract work whatsoever. The workmen paid sometimes as much as 2s. 6d. a week till they had settled their bill. It was necessary to employ a collector to get the bill paid by instalments, but this was more dignified and advantageous than the contract system. Dr. MUIR SMITH explained that at Eastbourne they had undertaken vaccination before the adoption of the amended Act and had no desire to continue it. Their movement had not a mercenary object ; its purpose had been to free the medical men who used to be bound hand and foot by the medical aid societies. Mr. HOUSMAN, in reply, said that he was glad to see that they were unanimous in their dislike of contract work. They would not now discuss whether this contract work should be organised by medical men and he was pleased to hear that in the North they had been able to dispense with it. He would accept the amendment arising out of Mr. Wolstenholme’s objection to the latter part of the motion. The motion would, therefore, read as follows :That club and friendly society contract work is undesirable in the best interests of both patients and the profession. On being put to the meeting in this form the motion was carried with but one dissentient vote, given by Dr. W. Muir Smith of Eastbourne. There were then 33 members present and several among them did not vote at all.

NAVY, ARMY, AND AMBULANCE. WEDNESDAY, JULY 30TH. The

PRESIDENT, Brigade-Surgeon-Lieutenant-Colonel G. S. ELLISTON, V.D. (Ipswich), in his opening address, said

the new army medical warrant would doubtless occupy a considerable portion of their time for discussion. The new warrant appeared to be a good one as far as it went. The Secretary of State for War practically adopted all the suggestions made to him by the journal and sub-committee of the Association, and, if administered in a fair spirit, a good class of young medical men would

that

sub-comenhanced of the Director-General in rank, position, and emolument. As a member of the War Office Council and Army Board he would now be able to exercise an important and beneficial influence, not only on the efficiency of his own department, but of that of the army at large in all that related to its sanitation." During the war in South Africa the Army Medical Department had come in for morethan its share of criticism and in the near future it might be the turn of the Navy Medical Service to go through the same ordeal, therefore it behoved them to be up and doing so as to be prepared for any eventuality. Mr. Arnold Forster, in his speech introducing the Navy estimates, said that the Royal Navy now had a hospital ship in the Mediterranean, and that steps were being taken to. provide material for three other hospital ships in the event of The hospital ship now in the Mediterranean was the war. Maine, which had been in commission for nearly a year ; her duty was to collect the sick from the squadrons and to convey them to the Royal Naval Hcspital at Malta, and if a large number of invalids had to be sent to England shebrought them home. The ship had proved an enormous boon to the sick, who were now treated afloat and were moved about with the greatest comfort and convenience. The three other ships for which material was to be provided for use in the event of war would carry a staff of naval medical officers and nursing sisters ; they would be in attendance upon the fleet during an action and would receive the wounded on board. Mr. Arnold Forster also stated that step’s were to be taken to provide the necessary material for a considerable number of additional ships for use as hospitals in case of war. Some of the experiences of the Japanese in the war with China showed the need of hospital ships to accompany the fleet into action. Now that the war in South Africa was over they might look back and realise the great work which the Royal Army Medical Corps had accomplished. In spite of the hostile criticisms and unfounded charges brought against the corps there was little doubt that the general verdict of the future would be that in no previous war had the sick and wounded been so well looked after as in that one. When the war broke out it was well known that the Royal Army Medical Corps was barely up to the peace footing it was really marvellous how the late Director-General succeeded in supplying the medical matériel and personazel with every unit that embarked. Of course, this could only be by the help of the various volunteer organisations : the Militia Medical Staff Corps supplied 500 men, the volunteers 600, and the St. John Ambulance Brigade furnished 2000 men. The feature of this war had been the way in which the volunteers and the civil and military portions of the medical profession amalgamated and worked together and the new departure of sending out 800 female nurses was attended with the best results. Considering the undermanned state of the Royal Army Medical Corps the War Office was fortunate in having these reserves to draw upon, and yet the chief organisers who bore the heat and burden of the day were allowed to leave the service without any official acknowledgment. Referring to this point the late Sir William Mac Cormac publicly stated that "no one who had not been in South Africa itself could know of the difficulties under which the medical department had laboured. They had been blamed for that for which those in other departments were responsible, and it was somewhat strange that the Government had allowed SurgeonGeneral Jameson to leave the army without the customary recognition given to every one of his predecessors and without one word of thanks or acknowledgment." All through the war a person could hardly read the casualty lists without being struck with the appalling loss of life from enteric fever ; the losses in the field were small compared with it, and sanitarians could not help thinking that much of it was due to preventable causes. In civil life the municipal authorities held the medical officer responsible and expected him to find out the cause and to suggest measures for stamping out the disease regardless of the cost. In military life this did not appear to be the case ; a general who had a large portion of his force down with enteric fever through want of ordinary precautions in guarding the purity of the watersupply and preserving the cleanliness of his camps did not get censured, but the sanitary officer whose advice was not taken was pronounced incompetent and indirectly was blamed. No doubt the sanitary officer in war must constantly be advising things distasteful to the combatants ;

and

done

392 remain on their ship, but together with their instruments and this was possibly why the post was abolished at The combatants, however,appliances should be relegated to a safe place. commencement of the war. Hospital --should bear in mind that by safeguarding their water-sup-iships were excellent but could not succour every ship and plies, attending to the sanitation of camps, and preventingeach fighting ship ought to be able to care for its own - ’infection of troops on the march, they were not only reducingwounded until such time as help could be obtained from a ,the amount of sickness but were adding to the effiency ofhospital ship. 3. The surgeon’s station. At present there was the field force as a fighting machine. The question ofno proper station assigned to the surgeon and it was desirable - sterilising drinking-water for active service was no new one,to have a properly equipped place and as far as possible free for Herodotus, "the father of history," recorded at the endfrom septic and insanitary conditions, as in the Japanese and of his First Book as follows : ’’ Now the great King (Cyrus) German navies. This place would be as useful in peace as in In war the surgeon and his instruments would be -goes on campagne with provisions carefully prepared at war. home, and with cattle. Moreover, he takes along with adequately protected. Poisonous gases were also factors to him water from the river Choaspes, which flows past Susa ; be taken into account. Hospital ships would not always be of the water of that river and no other does the king at hand, especially in running fights and isolated fights with .drink. This Choaspes water is first boiled off and a single ships and cruisers. Fleet actions might also cover too

the I

marvellous number of four-wheeled mule wagons carrying it in silver vessels follow him from place to place wherever he marches." So that 2500 years ago we find this great Persian monarch carefully attending to the purity of his drinking-water, and whatever happened to the rest of his army he took good care not to run any risk himself. The new army medical warrant did not refer to the volunteer medical service but the Secretary of State for War had recently granted some important concessions. Authority was now given for the formation of brigade bearer companies as independent units, on similar lines suggested in a paper .which he (the speaker) read before this section at the meeting of the British Medical Association in 1900. Another concession had been the incorporation of the Volunteer Medical Staff Corps into the Royal Army Medical Corps Volunteers) with the abolition of the compound title of the officers. They all felt that the Manchester Corps had well .earned distinction, that fine corps being upwards of 300 strong and having furnished strong contingents for service in - South Africa. A paper contributed by Staff-Surgeon W. J. COLBORXE,

large

an area.

He then

finally

treated in detail the duties of

the surgeons and assistants with reference to treatment and

transport of wounded in action.

The PRESIDENT commended Fleet Surgeon Kirker for his careful and practical paper and thanked him for the evident pains expended in its preparation. He pointed out the need for the efficient lighting of the dressing station, as also for the efficient yentilation. of the operation-rooms. There was no doubt that the "Kirker sleigh" was very well designed and he was surprised that it had not been adopted by the Admiralty before. Other nationalities had stepped in and had demonstrated its utility. Inspector-General A. TUR-.B13ULL, R N., retired (London), said that it was very interesting to note that there was a great deal in the old adage ot there being "nothing new under the sun." He had lately been looking up some old records and he found some Admiralty regulations dated 1730 and headed "Hospital Ships,"and these regulations showed that even then the arrangements were admirable. Hospital ships were things that could be very easily and rapidly equipped and fitted out. Cyrus and his water-boiling outfit was another instance of the new in the old. R.N., on Surgeon-General T. F. O’DwYER, A.M.S., said that unThe Duties of Medical Officers in Conncexion with a Naval doubtedly Surgeon Kirker was the first to draw attention Action to the matter in such a way as to attract public attention. ’Was read in his absence. He dealt with the subject under afterwards the Times publicly discussed the three heads : (1) preparation in time of peace ; conduct Immediately whole matter. There were two opinions in the navy-one during an action ; and (3) duties after the action. Each of represented by Surgeon Kirker, who held that such ships "these was handled with much technical detail. should have proper accommodation, and others who said that Fleet Surgeon G. KIRKER, R.N. (Haslar), read a paper on that was impossible. They as a nation seemed to be too The Treatment of Wounded in Naval Actions. conceited to learn from others. At Aldershot an American ,He said that certain scant information was obtainable from staff officer who had been sent to Europe to learn was not the records of the Chino-Japanese and the Hispano-American ashamed to learn from us. Both the navy and army wanted Public opinion was the .wars, and the missing details could be filled in by persons many more Lord Charles Beresfords. .acquainted with modern guns and battleships, suppcsing one only means by which these reforms could be brought about. miodern power were pitted against another..He had read aThe army had benefited by public opinion and the navy Nevertheless, the navy was paper last year at Cheltenham on the same subject under the would no doubt do so also. Public three heads—(1) the surgeon’s station ; (2) the time of treat- most conservative and did not like to change. ment ; and (3) the conveyance of the wounded. He would examination of these most important matters was what was now reverse that order and deal first with the conveyance! wanted, after first obtaining the opinions of those who built of the wounded. This matter depended on the means the ship, of those who had to fight her, and then, finally, .of conveyance-the stretcher-and on the openings andof the man who had the medical care of her. He dealt with the facilities, Surgeon-Major G. A. HuTTON, retired (Leamington), passages available for use. afforded by the "Kirker ambulance sleigh," which was so) believed that Sir Frederick Treves had stated that it was well received last year at Cheltenham and was then fully better not to attempt to attend to the wounded over and dealt with. He had made certain alterations in its con- above applying first temporary dressings whilst a battle was He also believed that the present Directorstruction since ; it was now collapsible and its transverse; proceeding. diameter could be increased or lessened at will. He hadt General was sent by the home Government to observe the provided perineal bands instead of the central saddle seat. arrangements in the Chino-Japanese war. There was now a lifting-sheet to place the patient on theSurgeon-Major G. K. POOLE, I.M.S., retired (London), stretcher and to remove him on to the operation-table.. would have liked the gentlemen contributing papers to have ..(The working of the stretcher, which attracted the interesttouched upon the matter of necessary procedure in cases of ..and warm praise of the assembled naval and militarycollisions and explosions, which might have been dealt with. 1 It was no new thing to have to make shift in the services. The " sleighhad - surgeons, was then demonstrated.) been tried in the Channel Squadron and had been on theThis discussion should be brought well before the authorities whole favourably reported upon and would now probably of the navy. The mercantile navy should also be efficiently officered from a medical standpoint. g be adopted by the Admiralty. There were two classes Dr. F. W. FORBES Ross (London) said that whether or not t of ships-those which possessed, and those which did not were agreed as to the desirability or otherwise of and down if ammunition hoists, , they these, present, possess, e the wounded men could be lowered during cessation of the properly equipping each warship or depended mainly on The hoists should open on each hospital ships, the fact remained that the "Kirker leigh passage of ammunition. was most useful in either event and especially in cases ,. deck to allow of the wounded being admitted to the hoist. This procedure would be very ,simple and easy with the involving the transport of the wounded by sea, from shore " Kirker sleigh." The hoists should in future, with this end to transport or hospital ship, or from ship to ship. Fleet Surgeon KIRKER, in replying, said that hospital in view, he constructed in a less constricted manner. 2.!. Time of treatment. The medical officers should not go on n ships were by all means to be provided and that he deck to treat the wounded, as efficiency was what was most ;t cordially advocated them and as many as possible should be . ’desirable and the medical officers should not be incapacitated d provided. All modern &hios were lighted by electric light. All d artificially and naturally ventilated above the armoured just when their services wou!d be most needed. They should

(2)

!

,

-

,

"

-

-

were

393 deck and mainly by artificial means below the armoured deck. The PRESIDENT put the following motion to the meeting, proposed by Surgeon-Major POOLE, and seconded by SurgeonGeneral O’DWYER:That it be a recommendation to the British Medical Association to to the naval authorities the desirability of improving the accommodation and arrangements for the treatment of the wounded on board ships in action, till they can be transferred to hospital ships or suitable hospitals on shore.

suggest

The motion

was

unanimously

endorsed.

malaria.

The four inhabitants of the hut remained per-

fectly healthy all the time, and, I believe, are so still. The experiments by the Japanese Government were carried out on the island of Formosa, and they furnish a most conclusive demonstration of the relations between mosquitoes and malaria. A battalion of soldiers who were completely protected from mosquitoes for 161 days during the malaria season escaped the disease entirely ; whereas there were 259 cases of malaria in another battalion in the same place and during the same length of time not protected from mosquitoes.

I am sure you will agree with the conclusions of Dr. Sambon and Dr. Low that their experiment prove that mosquitoes only are capable of transmitting malarial fever, that protecTROPICAL DISEASES. tion from their bite implies absolute immunity, and that protection can be easily obtained. If further proof is conWEDNESDAY, JULY 30TH. sidered necessary for large bodies of men it is furnished by President’s Address. the Japanese experiment. By a study of the life-history and Sir WILLIAM R. KYNSEY, C.M.G., the President, after a fewsurroundings of the anopheles and by varied and longpreliminary remarks, referred to the great work recently done continued experiment Ross has determined the best means by Laveran and others in malaria. He continued : "In the
steady