# Introductory lecture delivered to the class of military surgery in the University of Edinburgh, May 1, 1855

INTRODUCTORY LECTURE
DELIVERED TO THE
CLASS OF MILITARY SURGERY
IN THE
UNIVERSITY OF EDINBURGH
MAY 1, 1855.
BY
SIR GEORGE BALLINGALL,
REGIUS PROFESSOR OF MILITARY SURGERY.
EDINBURGH:
ADAM AND CHARLES BLACK, NORTH BRIDGE.
1855.
EDINBURGH:
PRINTED BY R. AND R. CLARK.
LECTURE.
Again, Gentlemen, I enter, without assistance, on the duties of this Chair. At the commencement of my last course of lectures I expressed myself in such a way as led my friends very naturally, and very truly, to conclude that I was prepared to retire'; and the general voice of his professional brethren in Edinburgh pointed to the late Dr. Mackenzie as my successor; and of his assistance I did indeed entertain the most sanguine expectation of being able to avail myself during the present course. It is your loss as well as mine, and it is the loss of the profession, that Providence has ordered it otherwise. A memoir of Dr. Mackenzie’s Life in the Edinburgh Medical Journals, both Monthly and Quarterly, as well as his private letters to ​me, and to other friends, show how speedily and correctly he fixed his eye on the points most essential to the health of an army—the position of encampments—the feeding of the troops—the prompt attention to the first symptoms of disease, and the cheering influence which the prospect of meeting the enemy has ever been found to exert on the health and spirits of a good soldier. He says, in a letter to me, in allusion to his own health, which had suffered before he left Varna,—"I have no doubt, however, that a day or two of the sea, and a sight of Sebastopol, will soon put us all to rights." I shall not, Gentlemen, attempt to add any thing to the encomiums which have so generally and so justly been paid by the public press to Dr. Mackenzie's merits. It was to the 79th Regiment particularly that his services were devoted, in conjunction with his friend Dr. Scot, an old pupil of this class, and of whom he says (speaking of the comparative immunity of the 79th from cholera), "This, I have no hesitation in saying, is due to the energy and efficiency of Scot and his assistants. I have seen much that shows me more than I could have believed, the importance to a regiment of having an energetic and a good surgeon." The manner in which my ​friend was cheered by the Highlanders on ascending the heights of the Alma, must have been, to a man like Mackenzie, who so rapidly imbibed the "esprit de corps" of a military surgeon, the most gratifying of all rewards for the services which he so largely and so disinterestedly gave. It was the cheers of the soldiery which warmed the heart of Ambrose Par4 on the ramparts of Mentz—of Percy on the banks of the Rhine—and of Larrey at the crossing of the Beresina.
[The Professor here craved the indulgence of the numerous friends who had been present on former occasions, while he laid before his pupils a sketch of the lives and writings of the Military Surgeons of byegone days; and after a short notice of the rise and progress of military surgery, particularly in the French and English armies, proceeded as follows:—]
Let us now, Gentlemen, turn from the events of the last to those of the present war—from the consequences of an autumnal campaign in Walcheren to those of a winter campaign in the Crimea—from the disasters of Flushing to the horrors of Scutari. But before going farther, I think it right to say, that if any of you have happened to look into the Lancet of Saturday ​last, 28th April, you will there have found a leading article on the introduction of the "civil element" into the military hospitals; so perfectly identical in spirit and in language with the views which I am now about to lay before you upon that point, that the coincidence can only be explained in one way. That explanation I believe I am able, and I am most willing to give. I communicated, at his own request, to a professional friend in London my sentiments upon this subject, a good many weeks ago, and every sentiment in the paper to which I refer, I am prepared to adopt. If my views are correct, they cannot be too often pressed upon the profession and the Government; if otherwise, I must answer for them; I alone am responsible; adsum qui feci in me convertite ferrum.
The sufferings of our army in the last campaign, 1854-55, have been such as to throw those of 1809 into the shade. These sufferings are now, by common consent, attributed to insufficient clothing and shelter, insalubrious or scanty diet, and, above all, to exposure and over-work in the trenches—circumstances for which the Medical Department is surely in nowise responsible. An outcry, however, was raised against this department very early ​in the day, for an alleged want of bandages and dressings—a want which seems to have been nearly, if not altogether imaginary—a want which I never could very well comprehend, seeing that there were hundreds, nay thousands, of our own men and of the enemy, lying dead upon the field, each with a shirt upon his back and another in his knapsack.
When sickness succeeded to accidents, when dysentery took the place of wounds, a clamour was again raised about the want of drugs. Looking to the quantity of medical stores despatched from this country, I should, were I entitled to express an opinion, say that there was rather an excess than a deficiency. On occasions of this kind, nothing can be more important than economizing our space, and diminishing the weight and bulk of articles to be carried; and care should be taken that medicines of acknowledged power are not overlaid by those of an indifferent or questionable character, or buried, wholesale, under stores of clothing and ammunition.
When carrying on war at a distance from our own shores, and in communication with a friendly power, it is not unnatural, nor is it improper, that we should lean upon the products ​of the country, and no medical man in our service would dream that the means of purchasing these would be either wanting or withheld. Had an officer pledged his personal credit upon such an occasion, and been thrown into prison for the debt, the country would have speedily come to the rescue. It is a remark of some of the older writers on physic, that almost every country is, found to produce remedies for the diseases prevalent in it; and it so happens that Turkey is a principal mart for some of the articles most essential in the treatment of diarrhoea and dysentery. Opium, rhubarb, and, I believe, castor oil, are there in abundance; and, if to these we add calomel, tartar emetic, and quinine (none of them bulky articles), we have almost every remedy of established efficacy in the treatment of fever and of dysentery, which have ever been the scourges of armies. I have always held an extensive knowledge of the materia medica to be of essential consequence to a military surgeon, and this not for the purpose of drenching his patients with drugs, but with the view that, when, upon foreign service, if deficient in the supply of one article, he should be able to substitute another of kindred properties—that he should, in short, be like a noted ​character in one of the old novels, Zachary Candle, whose great merit consisted in his being a clever hand at a succedaneum.
Under the pressure of such sickness as that which has prevailed at Balaklava and at Scutari,
I should be little disposed to indulge young surgeons in exercising their fancy, or experimenting with a variety of drugs. The administration of medicine, however necessary it may be to alleviate pain, or to aid in the cure of disease, is but little calculated to ameliorate the air of a crowded hospital, or to promote that cleanliness which, in such circumstances, is, of all medicaments, the most indispensable. I am not given to homoeopathy, nor am I prepared to subscribe to the doctrine of the late Mr. Knight, the Inspector-General of hospitals at the time I entered the service, who said to a surgeon, whom he thought a little too fond of drugging, that "he would carry as much physic in his breeches pocket as would serve him and his regiment for six months; and that soldiers wanted nothing but tartar emetic, and a big stick." The value of the tartar emetic 1 am quite ready to admit; and as to the big stick, the cases which suggested its use have greatly diminished since those days. Never ​was it less necessary than in the army of the Crimea; never was an army imbued with a better spirit; never were men more reluctant to give in, nor more patient under sufferings and privations.
One is entitled to learn wisdom from experience, and I cannot help thinking that, under a recurrence of similar circumstances to those with which the department has had to contend, the services of an assistant-surgeon, or, if you will, an apothecary to the forces, would be well bestowed, in despatching him as a sort of supercargo with every supply of medical stores, seeing them embarked, knowing where they were stowed, and keeping his eye upon them, until delivered to the authority destined to receive them. Were a cargo of such articles as I have pointed at, with a supply of splints and bandages, despatched successively in different transports, little could be wanting. But, above all, let no selfish, jobbing, or ignorant druggist be permitted to occupy space, and waste the public money, in supplying extract of liquorice (Scottice, black-sugar), instead of salts and senna. Of the former, I once saw boxes innumerable landing on the beach at Madras—a very potent remedy you will admit for sick soldiers, ​dying of fever, dysentery, or abscess in the liver.
It is. Gentlemen, in the hope of being able to suggest a few hints for your guidance that I have hazarded these remarks; and it is in the same spirit that would, with great deference, advert to what, so far as I can see, appears to have been the only defect of the Medical Department—an excess of good nature, in mixing itself, or permitting itself to be mixed, with the duties, and saddled with the responsibilities of another department.
There is all the difference between the duties of a purveyor and of a surgeon, that there is between food and physic, and it would be well that these were kept as distinct in their supply as in their exhibition. There are, indeed, some articles termed "medical comforts," such as wine and sago, brandy and arrow-root, which occupy a sort of neutral ground; and if the medical officer is ordered to furnish these, he has nothing to do but, like a good soldier, to obey; but even of these I should be glad to see him enabled to wash his hands. I do not see why he should, of necessity, be compelled to be a taster of wine or a connoisseur in brandy. If these articles are found to be faulty, there is always a means of ​redress through the orderly officer, who visits the hospital daily, for the very purpose of hearing complaints, and who (with all respect be it spoken) may be quite as good a judge of port wine as the doctor. Of this I am quite sure, that in the old war there were ten captains in my regiment better judges of this matter than I was. I have lived to see much in the medical department of the army—I have lived to see this department a second time declared unequal to its duties; but I trust that neither you nor I will live to see the Chief of the Medical Staff again reduced to the necessity of repelling offensive insinuations as to a missing cargo of wine.
It was my fortune to serve for some time in a quarter of the world where the purveyor, or commissary of the sick, and the surgeon were, until a recent period, combined in the same person—a combination most peculiarly favourable to the pocket of the surgeon, but not equally so to the health of his regiment. This is now happily abolished in all quarters of the world, and I am sure that no honourable or high-minded man will wish to see it revived. How far it ever was from meeting with my approbation, the following passage from my "Outlines," ​first penned some forty years ago, will serve to show yon:—"It may be very possible for a surgeon when lying quietly in garrison or cantonment to furnish provisions for his sick without much additional trouble; but whenever his regiment comes to be employed in active operations against an enemy, all his talents and exertions are then required in his proper capacity, and he has his hands abundantly full without having the complicated concerns of a victualling department to attend to. It by no means follows, that because a man is a good surgeon he should be a good commissary also, and it is obvious that whatever tends to withdraw his attention from the study and practice of his professional duties must ultimately prove injurious to the service." I have said much more on this subject in the passage from which I quote, but enough to show, that my opinions are not made for the occasion; and I will only add, that I see little that the surgeon has to do with the purveyor, except to demand from him the necessary supplies for the sick, and to report him to the General if they are not forthcoming.
It was not, however, with the differences between the purveyors and the medical officers ​in the hospitals on the Bosphorus that the difficulties of the medical department began. At the very commencement of this hitherto unfortunate war, long before a single shot was tired, it would appear that the most urgent representations were made by the Head of the Medical Department, and this, too, upon points of paramount importance to the health of the army—the clothing of the soldier—the formation of a numerous hospital corps—the appropriation of ships for hospital purposes, or for carrying disabled men to England, or to some intermediate station, so as to relieve the crowded hospitals at the seat of war.
How these very proper representations came to be so signally disregarded, it is not for me to explain. It may be only a part of that multiplication of office, and subdivision of responsibility of which the nation seems now so heartily sick, and which tends to render even a Commander-in-Chief in a great measure powerless. No man is better aware than I am of the evils which have arisen, and must arise, from a limited authority to the medical officers of the British army, but this would seem to have progressively increased since my time, and has now risen to a height which has placed the ​department not only in a false, but in a helpless and undignified position. It has risen to a height which calls aloud for a remedy, if the British soldier is hereafter to receive that assistance from the skill of the surgeon to which he has so nobly entitled himself— that assistance which I am sure it is the desire of the nation that he should receive.
In former days I have known a successful representation to issue from the weakest voice in the department. I have known an assistant-surgeon of three years' standing to bring down the censure of the Government upon the medical storekeeper at one of the presidencies of India, for hesitating to supply him, at once, with the articles he required. The young man's requisition was sent back to him for amendment, but instead of doing this, he stated the facts to his commanding officer, saying that the requisition should stand upon record, and if the storekeeper was unable or unwilling to comply with it, it was for him to say so, and to state "the reason why." The Colonel who, at the time, commanded a large army about to take the field, galloped off with the correspondence to the Governor, by whom the storekeeper was reprimanded, and the ​medicines were in camp in less than twenty-four hours.
I have known a young surgeon to bring his commanding officer to book, and to carry his point, by merely hinting at the proper statement in the proper quarter. The case was this—the regiment was stationed at Nottingham, partly accommodated in barracks and partly billeted in the town. Amongst those in billets were, as often happens in similar cases, a number of men with trifling ailments, who would soon be restored to their duty, by putting them under restraint and proper treatment. For this purpose the surgeon had repeatedly applied to the commanding officer for a room to confine these men, but having been repeatedly put off, he added a memorandum of the circumstance to his monthly return, and showed it to the colonel. The latter begged of him to cancel it, the quarter-master was sent for, and the room was given up to the surgeon before the sun went down. All this was done without an angry word, and the colonel was very soon made to see the good effects of putting his men on hospital stoppages and low diet, instead of permitting them to stroll about the town, to enjoy a full meal, and to regale ​themselves in the evening with pipes and Nottingham ale.
This, Gentlemen, is comparing small things with great, but it is illustrative of a principle from which I would advise you never to depart; to make a concise and distinct statement to the superior authority, whether military or medical, to emit no uncertain sound, to have no paltering, nor to make any compromise with those throwing obstacles in the way of the public service.
It is not, however, with military men, that the difficulties of the department have heretofore generally arisen, but with the underlings in 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 department?
I have already hinted that 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 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 take cognizance. 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, Gentlemen, was a man of the ​stamp of Larrey, to whom lie 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 surgeon-general (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 court-martial, 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 assistant-surgeons of the Navy; and I am sure they will sympathize 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 dose 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 clown 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 organization 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? is it that vexatious interference on professional points sometimes exercised by a philosophic 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 organization 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 characterize 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 £70,000 worth of stationery said to have been sent out with the army of the Crimea.
The absurd system of checks and counter-checks, 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-organization 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 assistant 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 Sir 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 Gobbet, 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 ophthalmia 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 ophthalmic 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 £60,000 per annum, which he had promised, by a reduction of the ophthalmic pensioners, not one has been sufficiently 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 ophthalmia, not one has been rendered fit for duty, and all have 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 the 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, I 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 said 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! 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 within 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 and 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, has 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 French, 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 soon forget the admiration which he expressed with the state of the regimental hospital in Piershill Barracks, then occupied by the 7th Hussars, and under the charge of an assistant-surgeon, Dr. Moffit. Not satisfied with this, he repeated his commendations to Sir James M'Grigor when he went to London, and wrote back to me to sav that he had done so, and that he had recommended to him the gentleman whom he was pleased to term my protegé. 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 congeries 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; but 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-fashioned notions in favour of the regimental principle, that I cannot help thinking it might with great advantage have 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 in 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 regiment with parties of sick, and it has happened to me to have served, more than once, in general and garrison hospitals, and to have sometimes had a portion of one of them given up to me for a regimental establishment, according to an arrangement which may, I believe, at this moment, be seen in the King's Infirmary, in the Phœnix Park, at Dublin, or at least was to be seen when I last visited that establishment 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 off, 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 was 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.
At the commencement of my last course of lectures, I promised myself numerous interesting communications from my friends serving in the war against Russia, and in this I have not been disappointed. I have lately had a letter from Dr. Hall, the chief of the medical staff in the Crimea—a man who has had both hard work and hard words—a man of much labour and little thanks. It is most gratifying to find him speaking confidently of the improved health and never-failing spirits of the men. From Dr. Deas, the head of the medical department of the Black Sea Fleet, and formerly a pupil of this class, I had lately a most valuable communication. He has conducted the duties of his department with much credit to himself, and with great advantage to the public service, notwithstanding the scarcity of hands in the ​junior ranks of the naval medical establishment. It would appear that he early detected, as an observant naval officer might be expected to do, the extensive prevalence of a scorbutic taint amongst all hands, soldiers, seamen, and marines, which rendered, in many instances, their dysenteries intractable, and their wounds incurable. From Dr. Linton, who was a frequent attendant in this class-room some two years ago, I had some touching details of poor Dr. Mackenzie's last hours, and of the earlier operations in the siege of Sebastopol. He was, and still is, at the head of the staff of the First Division, at one time so gallantly commanded by the Duke of Cambridge, who, I observe, has expressed himself fully satisfied with his medical officers.
Amongst other recent communications, I have had a very kind letter from Sir James M'Grigor, thanking me for a letter which I addressed some months ago to the Secretary-at-War, on the Medical Department. He evidently feels and deeply deplores what he calls the "black cloud" which has fallen on the department; expresses a confident expectation that it will right itself; and concludes with a well-known Scotch proverb—"We mann jouk and let the jaw gae o'er."
​It is with pleasure that I refer, for one moment, to another matter in which some of you are aware that I have taken great interest—the endowment of chairs of military surgery in the two other capital cities of the empire. From a reply by Mr. Peel, the Under Secretary-at-War, to a question put to him in the House of Commons by Mr. Grogan, the member for Dublin, it would appear that arrangements are making to carry out this measure. In Dublin, a class of military surgery has for several years been in operation, and I trust that the gentleman who has so well conducted it will speedily be commissioned by the Crown, and put in possession of an endowment. In as far as concerns London, I believe that one great difficulty has been the trouble and expense of removing the Chatham Museum to town, but this I have always looked upon as something very like a bugbear; nor have I ever been able to see why it should be the cause of one hour's delay. If the mountain cannot be brought to Mahomet, why should not Mahomet go to the mountain? How often did my late venerable colleague. Professor Jameson, cross the Forth with his pupils to illustrate his geological views by showing them the rocks on the coast of Fife? How often, and how far, ​does my excellent colleague, and former pupil, Dr. Balfour, go into the country to illustrate his botanical doctrines? He thinks nothing of going with his pupils to Aberdeen before breakfast, botanising for the day, and returning in the evening. As some indication that the Government has now come to see the propriety of encouraging special courses of instruction tor the rising generation of military and naval surgeons, I may mention that I have lately obtained, through the assistance of our city member Mr. Cowan, who kindly visited my museum that he might be able to speak to the point, a small grant of money for the purpose of putting that museum into better order, and reprinting my Catalogue, which I hope to be able to put into your hands before the close of the session.
This work was published before January 1, 1929, and is in the public domain worldwide because the author died at least 100 years ago.
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