In the Regimental Hospital, the surgeon may be seen going from the man who has lost a finger to a fever patient,—and then to one who has ophthalmia,—passing on to a fellow raving in delirium tremens,—next to whom is a sufferer under bronchitis, who will not be allowed to go out of doors for weeks to come; and if half a dozen are brought in with cholera in the course of the day, the officials do not know which way to turn. It is possible that the surgeon may be found making starch over the kitchen fire, because there is nobody at hand who understands how to make starched bandages; or he may be at the desk, casting up columns of figures, or writing returns, when he is urgently wanted at the bedside. Such things can hardly happen now; but they have happened within ten years. The Russians, meantime, would be carrying all manner of patients to one of their hospital-stations,—each sufferer to the hospital of his own division. The French would leave the men with scratches and slight diarrhea and delirium tremens in the Regimental Hospital,—would send the fever and bronchitis and scorbutic patients to the Divisional,—and any gravely wounded, or rheumatic, or other very long cases to the General Hospital at the base of operations.
Such arrangements, however, are of no use, if the last be not so organized as to render it fit to supply what the others cannot give, and to answer purposes which the others cannot even propose.
When doctors and soldiers alike shuddered at the mention of the General Hospital as a necessary institution at or near the seat of war, they were thinking of what they had seen or heard of during the Peninsular Campaigns. There were such infirmaries wherever there was a line of march in Spain; and they seemed to be all alike. Hospital gangrene set in among the wounded, and fever among the sick, so that the soldiers said, "To send a poor fellow to the hospital is to send him to death." Yet there was nothing else to be done; for it was impossible to treat the seriously sick and wounded at the spot where they fell. During that war, nearly twice the number which composed the army passed through the hospitals every year; and of these there were known deaths to the amount of thirteen thousand five hundred; and thousands more were never the same men again. When the case was better understood,—as during the last year in the Crimea,—the mortality in the hospitals barely exceeded that of the Guards in their barracks at home! Recovery had become the rule, and death a remarkable event. General Hospitals had come to surpass all other means of curing patients, while fulfilling their own peculiar service to society through new generations.
What are the functions of General Hospitals, besides curing the sick and wounded? some readers may ask, who have never particularly attended to the subject.
The first business of such institutions is undoubtedly to restore as many as possible of the sufferers brought into them: and this includes the duty of bringing in the patients in the most favorable way, receiving them in an orderly and quiet manner, doctoring, nursing, feeding, clothing, and cleaning them, keeping their minds composed and cheerful, and their manners creditable, promoting their convalescence, and dismissing them in a state of comfort as to equipment. This is the first duty, in its many subdivisions. The next is to obviate, as far as possible, future disease in any army. The third grows out of this. It is to improve the science of the existing generation by a full use of the peculiar opportunities of observation afforded by the crop of sickness and wounds yielded by an army in action. To take these in their reverse order.
There must be much to learn from any great assemblage of sickness, under circumstances which can be fully ascertained, even at home,—and much more in a foreign climate. The medical body of every nation has very imperfect knowledge of classes and modifications of diseases; so that one of the strongest desires of the most learned physicians is for an improved classification and constantly improving nomenclature of diseases; and hospital-records afford the most direct way to this knowledge. Thus, while the phenomena are frittered away among Regimental or unorganized General Hospitals, a well-kept record in each well-organized hospital will do more than all other means to promote the scientific understanding of disease.
The statistics of disease in armies, the ascertainment of the numbers who sicken and who die of particular diseases, would save more lives in future generations than can be now appreciated; but what can the regimental surgeon do towards furnishing any trustworthy materials to such an inquiry? A dozen doctors, with each his smattering of patients, can learn and teach but little while they work apart: whereas a regular system of inquiry and record, in action where the sick are brought in in battalions, is the best possible agency. Not only are these objects lost when surgeons are allowed to make the great hospital a mere receptacle for a cluster of small and desultory hospitals, but the advantages of a broad study of diseases and their treatment are lost. Inestimable facts of treatment are learned by watching, at the same time and in the same place, a ward full of patients ill of the same disease. People of all countries know this by the special learning which their physicians obtain in large civil hospitals: and the same thing happens in military hospitals, with the additional advantage that the information and improved art tend to the special safety of the future soldiery, in whatever climate they may be called on to serve.
There has long been some general notion of the duty of army-surgeons to record what they saw in foreign campaigns; but no benefit has been reaped till of late. The works of French field-surgeons have long been justly celebrated; but I do not know that in the statistics and the nomenclature of disease they have done much more than others. The English surgeons carried or sent home in 1810 a mass of papers about the Walcheren fever, and afterwards of the diseases of the Peninsular force: but the Director General of the Medical Department considered such a bulk of records troublesome, and ordered them to be burnt! Such an act will never be perpetrated again; but directors will have a more manageable mass of documents to deal with henceforth. With a regular system of record, at a central station of observation, much more may be done with much less fatigue to all parties.
But how is it to be done? may well be asked. In the hurry and confusion of a war, and amidst the pressure of hundreds of new cases in a day, what can the surgeons of the hospital be expected to do for science, or even for the improvement of medical and surgical practice?—The answer is seen in the new arrangements in England, where a statistical branch has been established in the Army Medical Department. Of course, no one but the practising surgeon or physician can furnish the pathological facts in each individual case; but this is what every active and earnest practitioner does always and everywhere, when he sees reason for it. His note-book or hospital-journal provides that raw material which the statistical department is to arrange and utilize. The result will be that a flood of light will be cast on matters affecting the health and life of soldiers and other men, in regard to which we might have gone on groping for centuries among the confusion of regimental records, without getting what we wanted. As to the method of proceeding, I may have something to say farther on. Meantime, we must turn to the primary object of the institution of the Military Hospital,—the cure of the wounded and sick of the army.
In the case of active war, foreign or civil, the General Hospital is usually an extemporized establishment, the building a makeshift, and the arrangements such as the building will admit. In Spain, the British obtained any houses they could get; and the soldiers were sometimes crowded into half a dozen of them in one town. In the last war, the great buildings at Scutari were engaged three months before they were wanted for extensive use; so that there was plenty of time for making them clean, airy, warm, and commodious, and for storing them with all conveniences. This was not done; and the failure and its consequences afford a lesson by which every people engaged in war should profit. A mere outline of what was not done at Scutari may be an indication of what should be done with all convenient speed elsewhere.