Wars of conquest bring about curious results and in unexpected ways. While greed, lust and fanaticism have been the three great impelling and underlying motives for most of the wars which man thrusts upon his fellow-men, one far nobler motive has been the occasional and the only just cause of strife, namely, the desire for liberty; still this is always secondary and the product of some other man's or people's greed. As only by the cataclysms of the natural world has it been prepared for man's habitation, so by some wars have come benefits unforeseen, with an amelioration of the condition of mankind in general, which could not have been secured by any less drastic measures. It is, however, a sad commentary on man's intelligence that most honor is paid to those who have taken the most lives rather than to those who have saved them. No school boy in the remotest districts but is brought up with some trifling knowledge of the world's heroes, so-called, though they were in reality the world's wholesale murderers. Yet you may find many persons, credited with higher education, who are still densely ignorant of the benefits conferred by those two greatest discoveries in the world's history (both of Anglo-Saxon origin), anaesthesia and antisepsis, who will talk entertainingly and at length of Darius, Caesar, Hannibal and the more modern military lights, yet who never heard of Morton nor of Lister. Yet if to-day you inquire what is doing in the various parliaments of the world you learn that the talk is ever of more numerous and more powerful engines of destruction, and that those in power have no time to devote to improvements in the army or navy medical service, and that it is even now impossible to secure anything like adequate attention to our needs in this direction.
Means of taking human life must be constantly at hand; means of saving it are of small importance until the emergency has arisen; and then the blame for inadequate provision of both means and men falls not where it belongs, on the politicians who would not look ahead, but upon the administration of the medical department, who work to the point of desperation and despair in times of peace, who keep perpetual vigil, with scant recognition of the sacredness of their purpose, and scant aid in its accomplishment.
Are the lessons of the South African, the Spanish-American and the Russo-Japanese wars to be forgotten almost before they have been recited? Are we prepared to-day to give adequate care and attention to our soldiers and sailors were war in sight? You well know that we are not; every military or naval surgeon knows we are not; the medical profession generally knows it; and our legislators have been told it until we are tired of repeating it. Yet, what is the result? The same indifference on their part, the same ignorance of what it all means; and on the part of the public the same blindness and fatuous confidence that "everything is all right."
For instance, if an adequate medical service is to be built up for war there should be one officer to every 100 of enlisted men. Estimating that an army of at least 400,000 men would be required were we engaged with a first-class power—and what other would dare to engage with us?—this means 4,000 army surgeons. Of these at least one-fourth should be regular and experienced medical officers. In other words, there should be for such an army at least 1,000 medical officers in the regular service, and also at least 3,000 volunteer surgeons, professionally and physically equipped for such work. Should anyone object that this exceeds all the provisions of time past, the reply is ready and all sufficient, namely, that in time past all such provisions have been utterly inadequate; that the conditions of modern warfare have undergone an entire change, that a sick, wounded or disabled man is an encumbrance, and that it behooves us to prevent sickness, and to cure the disabled man as quickly as possible. Furthermore, advances in medicine and surgery have been so great that far more is now expected of the medical corps than ever before, and it is a duty which we owe to those who incur the dangers of fighting for us that we should care for them. We are, therefore, under the very highest moral obligation to give them our best, and enough of it. It must be a small inducement that we offer to men to fight our battles if we permit them to feel that they are not objects of our solicitude when sick or wounded.
There is another feature which we cannot disregard. So long as army regulations require that a man educated in advanced science spend much of his valuable time in acting as bookkeeper or clerk, there will be less inducement to enter the service, and it will consequently not attract men of highest proficiency. That which is required of you is complicated and exacting. You must be good bookkeepers, good sanitarians, and equally good surgeons, physicians and even obstetricians. Above all, you are expected to be able to keep all the men under your supervision ready for the "firing line" at a moment's notice. You have received the highest compliment which the State can pay when you have been adjudged versatile and competent enough to fill all these rôles and do all these things.
Moreover, as you gain promotion other things will be expected of you, even, I hope, the filling of the chairs in this modern Military Medical School. It is in a way the West Point of the medical corps, and it would seem as though there should not be the slightest difficulty in replenishing vacancies in its faculty by detail from your ranks. The collections and the literary labors of your corps constitute to-day treasures exceeded in value by but few if any in this, the Nation's Capital. The library, the museum and the archives of the medical department have been models from which all the nations of the earth have copied.
In this connection there occurs to me, by way of contrast, the story of a French surgeon's experiences when he undertook to teach anatomy in a conquered and reconstructed country.
After the French occupation of Egypt, Mehemet Ali took it into his head to introduce European civilization into Africa, and imported all sorts of artists, scientists and medical men, among them a practitioner of Marseilles, a true Bohemian in the modern acceptance of the expression, who presented himself in most seedy apparel, saying, "I am a doctor of medicine, with plenty of courage, but no clothes; I want to try my fortune." This man was Dr. Clot, who rapidly became a favorite of the Viceroy. He soon learned Arabic so as to speak it fluently, and in six months not only received an army commission, and became a Bey, but took the chair of anatomy in the newly organized school of medicine. Conditions were all against him. Mussulman fanaticism and the prohibitions of the Koran opposed all anatomical pursuits, and so soon as he proposed a dissection there was a general explosion. By Mohammedan ceremonial one who even touches a dead body is thereby rendered "unclean" for seven days. The Ulemas, the Muftis, and all of the other fanatics, demanded of the Viceroy the closure of the school, and declared dissection a sacrilegious profanation. Mehemet refused this, and ordered Clot Bey to commence his demonstrations. Then one day happened the following incident: The professor, scalpel in hand, standing alongside the cadaver, began to open the thorax, when one of the students, either from sheer fanaticism, or more bold than the others, jumped upon him and stabbed him with a poignard. The blade slid over the ribs, and Clot Bey, perceiving that he was not seriously hurt, applied a piece of plaster to the wound, observing as he did so, "We were speaking of the disposition of the sternum and the ribs, and I now can illustrate to you why a blow directed from above has so little chance of penetrating the cavity of the thorax." He continued his lectures, and turned out some skilful practitioners. He became an officer of almost every order in the world, and acquired more than sixty decorations, although he never wore but one, the red rosette of his own country. (Med. Times and Gazette, September 19, 1868.)
While just such an experience may never be duplicated again, the Philippines, or some other country yet to fall under our rule, may afford an opportunity for a similar display of sang froid.
While no one may see far into the future, the maxim, "In time of peace prepare for war," is as true of the medical department as of any. Were it a state secret no one would breathe it here, but it is lamentably true and publicly known that even now we are not prepared as we should be. The awful lessons of the Spanish War have been forgotten. West Point officers have until comparatively recently received no instruction in camp sanitation. Some of us worked hard a while ago to have at least elementary instruction in it introduced into their curriculum. As an illustration I believe that to-day they are taught more about horse's feet and how to keep them in good condition, than about those of their men. Line officers, especially volunteer, have never been too ready to locate their camps where water and drainage were the best, and the awful mortality of the Spanish War was mainly due to preventable disease, while this was due to stupid and inexcusable disregard, on the part of officers of the line (mainly volunteer) of the advice of their medical officers.