Army Medical Service

Training.

Officers of the R.A.M.C. attend preliminary and post-graduate courses at the Royal Army Medical College, and military training with the men at the R.A.M.C. Depot at Alder shot, where there is also an army school of hygiene. In America, an army medical centre was opened in 1923, at Washington, Dis trict of Columbia. It consists of the Walter Reed general hospital and schools for the training of the medical, dental, nursing and veterinary corps. There is also a medical field service school at Carlisle, Pennsylvania, and a school of aviation medicine at San Antonio, Texas. In Italy, there is an army medical school at Florence, and in France, at Lyons, in addition to the post-graduate school at the Val-de-Grace, for student candidates.

In the British Army, military hospitals and small depot hos pitals are established in all commands. In America and its insular possessions there are garrison hospitals and seven large general hospitals, similar to some of the larger military hospitals in Eng land. In continental armies there are also garrison hospitals, but in France, military sections of the civil hospitals take their place to a great extent. In some continental armies most of the medical and surgical material is or was prepared in army medical labora tories and factories. In Great Britain and America it is distributed from army medical stores, that for the British Army being at Woolwich.

War Organisation.

A regimental medical service, field am bulances, casualty clearing stations, general hospitals, convalescent depots, advanced and base depots of medical stores, motor ambu lance convoys, ambulance trains, hospital ships, field hygiene sections and mobile hygiene, bacteriological, X-ray and dental laboratories come into being for service with a British Expedition ary Force on the outbreak of war; there are equivalent units in other armies under different names and organisations. To complete their personnel on mobilisation the medical and nursing reserves are called up. For this purpose there is a regular reserve of R.A.M.C. retired officers and men liable to be recalled to service, a supplementary reserve of officers, a military hospital reserve of the St. John Ambulance Brigade, the Territorial Army R.A.M.C. and the Voluntary Aid Detachments (under T.A. County Assn.) of the British Red Cross Society, the St. John and the St. Andrew Ambulance Associations. There are also important reserves of Queen Alexandra's Imperial Military Nursing Service and the Territorial Army Nursing Service. But in a great war, practically the whole of the country's medical resources may be enrolled within the limits of age. In the World War, the peace establish ment of the R.A.M.C. thus expanded to 15,000 officers and ranks ; while in the United States Army the medical service (vet erinary excluded) expanded to 38,140 officers and 264,181 other ranks. A similar vast expansion occurred in nursing personnel (21,480 nurses, U.S.A.), and in the number of medical units. Military hospital beds, for example, reached a total of 637,746 for the British forces and 407,914 for those of the United States. The various units are distributed in the war zone, from front to base, in divisional, corps, army, and lines of communication areas of command, according to the nature of the functions for which they are organised. The regimental medical service consists of an officer of the R.A.M.C. with 21 men of the regiment as stretcher bearers and 16 as sanitary detachment. In battle, a regimental aid post (Fr., poste de secours; Ger., Truppenverband platz; It., posto di medicazione), to which they collect the wounded, is established. Each division has three field ambulances (the equivalent of the medical regiment of a U.S.A. division, the groupe sanitaire divisionnaire of the French, and the Sanitiits battalion of the German organisations). A field ambulance is corn

posed of a headquarters and two companies, the headquarters being destined to form a main dressing station and each company an advanced dressing station. With a cavalry division there are two Cavalry Field Ambulances, each consisting of a headquarters and one company.

In battle, the Field Ambulance opens an advanced dressing station at a point to which its wheeled ambulance transport can be brought, and a main dressing station further back. The corn pany removes the wounded from the regimental aid posts to the advanced dressing station, and the transport brings them from there to the main dressing station. The motor ambulance convoys (Fr., section sanitaire auto), composed of 75 motor ambulance cars each and with one convoy to each corps, bring the wounded from the main dressing stations to the casualty clearing stations (U.S.A., evacuation hospital; Fr., hopital d'evacuation; Ger., Kriegslazarett), which are established in the proportion of one to each division, at or near railways and at the head of the lines of communication. From there, when fit to travel, the sick and wounded are taken in ambulance trains to the general hospitals, which are units of i,000 or less beds placed at sea bases or other convenient centres. Hospital ships transfer the patients to home ports, whence they are distributed to hospitals throughout the country. Such is the normal system of collection, evacuation and distribution of sick and wounded in a war zone. It is liable to modification according to circumstances and the nature of the terrain, especially as regards methods of transport by road, rail, river, canal or air. It worked well in the World War, where the test was severe. During the battles of the Somme, for example, the British field ambulances collected 316,073 wounded between July 1 and Nov. 3o, 1916, including 26,675 in the first 24 hours; 304,285 were transferred to the base hospitals, and on one day, July 6, arrived in hospital ships at Southampton and Dover.

The mobile laboratories and advanced depots of medical stores are usually placed with or near the casualty clearing stations. For sanitary duties a Field Hygiene section, of one officer and 27 men, is allotted to each division and base, and sanitary squads of five men each to small posts, such as railheads. Their influence and that of medical research had remarkable results during the World War in preventing disease. Enteric and typhus fever, the scourge of armies in past wars, became negligible quantities in the British and American forces, and fatal gangrene of wounds and trench fever, for long a cause of much inefficiency, were brought under control. Indeed, the two outstanding features of the army medical service of the present day are its power of controlling disease and its power of systematically, rapidly and effectually bringing battle casualties under life-saving surgical and hospital treatment. In this beneficent work it is assisted by voluntary aid organisations. Amongst all civilised nations there are national Red Cross socie ties (see RED CROSS) organised as auxiliaries of their army medical services in time of war. They are of special value in distributing voluntary gifts and comforts, such as are not supplied through official sources, to the various hospitals in the home territory and in the war zone, in organising auxiliary hospitals and in various other activities. Those recognised by their governments, together with the whole of the personnel and units of the medical services of armies, are protected and become the recipients of special privileges under the Geneva Convention of 1906, should they fall into the power of the enemy during war. (W. G. MA.)