Between Flesh and Steel (29 page)

Of the 225 medical officers serving in the British Army's medical service at the beginning of the war, only 52 had medical degrees, while the rest had surgical diplomas.
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The quality of the military surgeons' medical training was close to what it had been a half century earlier at Waterloo. Curiously, most British military physicians and surgeons were of Irish and Scottish descent.
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Doctors from these areas lacked civilian opportunities as a consequence of class discrimination, so many entered the military to gain position and experience. Although the number of military physicians eventually grew to approximately a thousand during the war, it was never sufficient to handle the extensive casualties. British authorities argued, however, that the ratio of 1 medical officer to 77 men under Lord Raglan (1788–1855) was better than the ratio in the Peninsular War when British forces had 1 medical officer for every 145 men. It was also noted that the French had only 276 medical officers compared to the British 406, even though the French Army was twice the size of Raglan's force.
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The British ambulance corps was woefully inadequate. Although a few prototypes of the Larrey-type ambulance evacuation wagons had been produced, their number was far too small to provide adequate support. Moreover, these few vehicles arrived late behind the deploying army, and since the quartermaster did not give the corps horses, drivers, or carpenters to assemble the wagons, they had to leave the vehicles in Varna. Each regiment was issued eight stretchers but no litter corps to bear them. Any available men for stretcher duty had to be drawn from the line regiments,
a situation that often led to mustering the regimental band members, the recovering sick and wounded, and whatever few men the regimental commander cared to spare. When the army proposed hiring local Turks and Bulgars as stretcher bearers, London denied the option as too expensive. As the casualty death rate mounted, however, the War Office ultimately provided for raising a Hospital Conveyance Corps to act as stretcher bearers. To keep costs down, the corps recruited from old pensioners and low-status personnel whose only virtue was their willingness to work for low wages. This small corps arrived in Varna in July during a cholera epidemic and was immediately incapacitated by the disease. Because the British failed to plan for medical support, they never succeeded in establishing a regularized system of ambulances or stretcher bearers during the war. Instead, the physicians had to go into the line and treat the wounded in the trenches where they fell.

To move the wounded and sick to hospitals, the British improvised and had the navy ferry casualties from the Crimea to the two major base hospitals three hundred miles away in Turkey. Conveying the casualties from the line to the ports remained a major difficulty throughout the war, and the poor means of overland transport caused many deaths. The navy had plenty of ships to accommodate the casualties once they arrived in port, but it had no organized system for loading them. As a consequence, the wounded and sick often lay in the rain for one or two days until placed aboard. Further, only a handful of ships were modified to house and care for casualties. Most often no trained medical personnel and few medical supplies were on board. Overcrowding also became a problem. One ship, the HMS
Kangaroo,
was equipped to carry 250 casualties but packed aboard more than 1,500 sick and wounded on a single trip.
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Loss rates among the sick and wounded of 20 percent were common, and soldiers arrived at the hospital days after being wounded still in their dirty, mud-covered uniforms and with their wounds untreated.
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Only in the last year of the war did the British medical service establish regularly scheduled steamships for ferrying the wounded from the front to the general hospitals in the rear.

The general hospitals, however, were little more than pestholes. The largest hospital, at Scutari, had no beds, so patients lay on the floor with the same clothing or blankets they had brought with them from the front. It did not have a kitchen to prepare food, and its two thousand patients were expected to make do with only twenty bedpans. The British did not even create a corps of hospital orderlies until the end of the war. It took the arrival of Nightingale and her nurses to improve the basic sanitary conditions of the British general hospitals. Their simple sanitary procedures,
such as providing bedding, changing sheets, wearing hospital gowns, and regularly washing the physical plant, drastically reduced the rate of death from disease and infected wounds.

Dr. John Hall (1795–1865) oversaw the British medical system in the Crimea. His medical staff of fifty-six men included a director of hospitals, forty surgeons and assistant surgeons, a medical storekeeper, and fourteen noncommissioned officers. The regimental medical system, in place for more than a century, remained intact for all its faults. The regiment's medical assets stayed in the hands of the field commander, however, and medical personnel had no authority to coordinate medical care between regiments. The regimental hospital, also a relic of earlier days, was equipped with only twelve beds with blankets and sheets, a medical chest, and a pannier of medical supplies for the horse carriage. The bell tents could only be closed from the outside, and the treatment of most casualties occurred on the ground.
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Most trained physicians served in the general hospitals, leaving the regiments with the least trained personnel to deal directly with the wounded. From the start, the number of casualties overwhelmed the regimental system, and it never recovered its ability to deal adequately with the wounded.

The poor organizational structure of the British military medical service in the Crimea was equaled by the generally poor medical treatment it offered. Dr. Hall had strong suspicions about chloroform and believed that the pain associated with surgery served to heighten the body's ability to fight and survive amputation and infection. Although he did not prohibit it, Hall issued a warning on the use of chloroform that the younger surgeons took to mean that they ought not administer it regularly. The best trained and more experienced surgeons still widely used chloroform, but Hall's directive kept the supply service from making chloroform a priority item to stock.
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Accordingly, chloroform was always in short supply, and the British missed an opportunity to standardize anesthesia's use in battlefield surgery. Generally, the medical establishment also was strongly opposed to using chloroform. As late as 1857, the Crimean Medical and Surgical Society, an organization formed among surgeons who had seen service in the Crimea, warned against the general use of anesthesia.
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The medical horrors of the Crimean War provoked such a public outcry in the press and in Parliament that some reforms were attempted. Most, however, were not implemented in time to improve medical treatment during the war. In 1855, the medical service formed a corps of hospital orderlies consisting of nine companies of seventy-eight enlisted men to staff the general hospitals. After the war the corps
became the Medical Staff Corps and a permanent part of the medical service.
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An inspector general's postwar report led the British for the first time to establish a regular strength and resource table for medical assets. From then on, a medical corps of 280 men would be authorized for every division of 10,000 men. Unfortunately, the report did not address the formation of a stretcher or ambulance corps, and none was established on a permanent basis until the Second Boer War. In 1860, the first British military medical school to train military surgeons was established at Fort Pitt, and a system of regular medical reports was instituted throughout the army. In 1874, the regimental system, including its hospital system, was abolished to make way for new, larger fighting formations. The new hospital system, copied from the American experience in the Civil War, was organized around divisional units. In 1878, the army brought medical officer pay, privileges, and ranks into line with the rest of the service, but it still denied medical officers the privileges of command and needed the permission of their field commanders to gain control over medical resources. In 1890, the medical corps was placed on the same social and military level as the corps of engineers, and in 1898 its designation was changed to the Royal Army Medical Corps.
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The French medical corps was outdated, disorganized, and still suffered from the organizational and political effects of the army's defeat at Waterloo. The political suspicions accompanying the Restoration compounded these problems, and the destabilization of the Revolution of 1848 and the rise of Napoleon III (1808–1873) followed. The turmoil of 1848 provoked widespread street fighting, and the French medical corps was pressed into service to treat the casualties with two significant results. First, French surgeons gained experience in using chloroform and standardized its use in the medical service. When the Crimean War broke out, the French administered chloroform as a matter of course and did so, they claimed, in thirty thousand operations during the war.
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Second, the political authorities recognized that the military medical service needed reform. In April 1848, the service began allowing its officers to exercise independent command of their own personnel and resources. The French were the first to take concrete steps to create an independent and autonomous military medical service. Unfortunately, when Minister of War Gen. Alphonse Henri d'Hautpoul (1789–1865) reversed these reforms a year later, the French medical service plunged into another period of disorganization.

General d'Hautpoul's actions almost destroyed the service. He ordered that surgeons, physicians, and pharmacists be recruited exclusively from the graduates of civilian training institutions, so the French Army dismantled its military medical educational establishment. To prepare civilian medical personnel for military service, d'Hautpoul directed that they must take a one-year course in military medicine at the École d'Application de la Médicine Militaire at Val-de-Grâce. A year later, the French medical service equalized the status of physicians and surgeons by prescribing essentially the same refresher training for both, but it made no effort to assimilate these disciplines into the military's ranks.
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The wars of Napoleon III all resulted in major medical disasters. Under d'Hautpoul's medical system, the French entered the Crimean War with an acute shortage of medical officers, physicians, and surgeons. Before the war, the medical recruitment system had failed badly, and once the war broke out, it flunked completely. Few civilian medical personnel could be convinced of the value of military service, resulting in a precipitous decline in both numbers and quality. Between 1853 and 1855, of the eighty medical officer recruits required to fill out the ranks annually, the service attracted fewer than fifteen a year to take the examination. More damaging, of these, only four per year passed.
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During this period, the French Army in the Crimea expanded by ten battalions of infantry, enlarging the cavalry and artillery forces and creating an Imperial Guard. The French medical service never deployed sufficient medical personnel to serve this increased force. Moreover, of the 550 medical officers that served in the Crimea, eighty-three officers, or 15 percent, lost their lives.
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The medical disaster in the Crimea had even further negative consequences for the French medical service. The few remaining physicians after the war quickly left military service for calmer lives. Although the French created a new medical school at Strasbourg to train their replacements, it attracted few students. The service reduced the number of surgeons assigned to each division to four, but most regiments had only a single surgeon, who was usually an untrained assistant, or none at all. The ambulance system, never fully staffed, was allowed to decay to even smaller numbers. When war broke out with Italy in 1859, medical talent was in such short supply that in place of the required 150 physicians and 150 surgeons, the medical service had to make do with 200 untrained medical students to serve as assistant physicians in the regiments.
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The Battle of Solferino (1859) demonstrated that the French had learned nothing from their medical experience in the Crimea. The medical service was short of physicians, surgeons, nurses, dressings, ambulances, hospitals, surgical instruments,
rations, anesthesia, and general transport. Henri Dunant, an eyewitness to the battle, found the slaughter and neglect of the wounded and sick so appalling that in 1862 he published
Un Souvenir de Solferino
(
A Memory of Solferino
), portraying the horror to the world. His work provoked a conference of the national Red Cross societies in Geneva in 1863 that led, in 1864, to the founding of the International Committee of the Red Cross and to fourteen nations signing the first Geneva Convention regulating the treatment of the wounded and conferring noncombatant and neutral status on the medical personnel of the national armies. The convention also adopted the red cross as the international symbol of the military medical services.

The Red Cross convention prompted France to create a Society for the Aid of Wounded Soldiers. When war broke out with Germany in 1870, the French medical service still was as ill prepared as it had been for the last war. French soldiers carried no first aid kits, and the medical service had no litter bearers, few ambulances, and no organized ambulance transport services attached to the regiments. Medical help to the soldier essentially stopped when he was dumped behind the regimental aid station, for no organized method existed to systematically move the wounded to interior hospitals. The medical supply storehouses were located too far to the rear to move supplies rapidly; however, within a few weeks, they ran out of medical supplies completely. The lack of a reserve pool from which to draw replacements compounded the shortage of physicians and surgeons. Because the French had also forbidden the use of inoculation, more than 200,000 soldiers contracted smallpox during the course of the war.
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The high death rates from wounds, infection, and disease prompted one commentator to refer to the period as “the most grievous in the history of French demography in the 19th century.”
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