358 JGcboes from tbe past. LETTERS FROM (THE LATE) SIR THOMAS LONGMORE FROM THE CAMP BEFORE SEBASTOPOL, 1855. Light Division, Oamp above Sebastopol, February 16, 1855. My DEAR BIRKETT,-I have been intending mail after mail to reply to your letter which I received, I am ashamed to say, six or seven weeks ago. I was very glad indeed to hear from you, and I thought it very kind on your part to think of writing. I am sorry to say that the deficiencies, which you supposed existed and which the newspapers have described, in the medical arrangements and affairs of the Army have n,ot been exag- gerated. Shortly after the battle of the Alma I wrote home a very strong letter, which an uncle of mine published in the Daily News of November 8, 1854. I wrote at some length; it occupied nearly three columns of the newspaper. I regret I did not ask my brother to show you the letter. But it was not only after Alma, it was long before, in Bulgaria, that I and others saw what must happen, badly appointed as we were in respect to transport and hospital equipment, and subject so completely to the caprice of the military authorities under whom we were acting. We did not know it would be so bad as it has been in the Crimea, because we did not know that we were to be deprived of all our ordinary hospital armament, limited as that was, on landing and taking the field. All my hospital boxes, &c., were left behind either at Varna, or in the transport which carried us to Kalamita Bay. I brought two small panniers, on a vicious brute of a pony which I could not get exchanged, and which was always the cause of trouble to me, and those contained all the surgical and medical stores I had for my regiment, excepting a few stretchers carried by the bandsmen. I have reported everything to the Commission sent out by the Duke of Newcastle. You must know < that I am one of the troublesome medical officers of the Army. I and copyright. on 19 May 2018 by guest. Protected by http://jramc.bmj.com/ J R Army Med Corps: first published as 10.1136/jramc-02-03-17 on 1 March 1904. Downloaded from
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358
JGcboes from tbe past.
LETTERS FROM (THE LATE) SIR THOMAS LONGMORE FROM THE CAMP BEFORE SEBASTOPOL, 1855.
Light Division, Oamp above Sebastopol,
February 16, 1855. My DEAR BIRKETT,-I have been intending mail after mail
to reply to your letter which I received, I am ashamed to say, six or seven weeks ago. I was very glad indeed to hear from you, and I thought it very kind on your part to think of writing.
I am sorry to say that the deficiencies, which you supposed existed and which the newspapers have described, in the medical arrangements and affairs of the Army have n,ot been exaggerated. Shortly after the battle of the Alma I wrote home a very strong letter, which an uncle of mine published in the Daily News of November 8, 1854. I wrote at some length; it occupied nearly three columns of the newspaper. I regret I did not ask my brother to show you the letter. But it was not only after Alma, it was long before, in Bulgaria, that I and others saw what must happen, badly appointed as we were in respect to transport and hospital equipment, and subject so completely to the caprice of the military authorities under whom we were acting. We did not know it would be so bad as it has been in the Crimea, because we did not know that we were to be deprived of all our ordinary hospital armament, limited as that was, on landing and taking the field. All my hospital boxes, &c., were left behind either at Varna, or in the transport which carried us to Kalamita Bay. I brought two small panniers, on a vicious brute of a pony which I could not get exchanged, and which was always the cause of trouble to me, and those contained all the surgical and medical stores I had for my regiment, excepting a few stretchers carried by the bandsmen. I have reported everything to the Commission sent out by the Duke of Newcastle. You must know < that I am one of the troublesome medical officers of the Army. I and
Watt, of the 23rd, run in couples. From the time we were at Devna to the present time, we have been constantly writing official let~ers, complaining, remonstrating, warning, and in short, as the military people call it, "making difficulties" of every sort. We have equally written through our Colonel to the General Officers, and through the Staff-Surgeons to the Head of our own department. We could not have done so had we not been supported by the head "medicine man" of our division, Dr. Alexander, whose name has been often mentioned in the papers. I believe he has been the only independent man in his position-stating plainly and bluntly that the Regimental Surgeons have been without the necessary accommodation and medicines for the treatment of the sick. At Monastere I wrote such a letter about being without medical comforts for the hospital when it was full of cholera, and diarrhma was prevailing-backed by my Colonel-that a general hubbub was created; my complaint, however, was proved to be "frivolous" by General Airey (now Quarter-master-General) and shortly afterwards a friend who had been dining with Lord Raglan told me that he had mentioned to him something about there being "a screw loose" in the Medical Department of the 19th Regiment. I fear my prospects of promotion are, done for, but that affects me very little, as I would rather remain a regimental surgeon than take promotion in the present system of medical affairs. Dr. Hall, appears to me to be a theorist, all his faith seems pinned upon returns-l have seen no evidence of his being a practical man. I cannot understand how he condescends to retain his office after the wigging he got from the Commander-in-Chief in General Orders. I am quite certain that had he insisted on our having in the field the necessary ambulances, &c., Lord R. dared not have faced public opinion and refused the demand; if he did, Dr. H. should immediately have left the position he must have well known he could not keep, under such circumstances, with credit to himself or the Department, or benefit to the sick and wounded. I am equally certain that had Dr. Hall exhibited the necessary , method, energy and firmness, we should never have been without our proper supply of medicines and medicaments in the Crimea-for you must recollect that along the march we were in communication with our ships and transports, and ever since
the ports of Balaklava and Kamiesch have been opened we have been in constant communication with Constantinople and the depots of stores at Scutari. Even so late as the beginning of the present month we could get hardly any medicines. To an urgent complaint on this head made by Watt, Dr. Hall wrote through the surgeon of the division, Dr. Alexander, that perhaps Dr. Watt had better try the use of charcoal, there was plenty of that. I must send you a copy of Watt's reply-it is rather satirical. But imagine when our hospitals were full of frost bites, scorbutic dysentery and general emaciation, and cachexia from overwork, want of food and clothing, and all kinds of exposure-fancy his coolly sending to a regimental surgeon to "try charcoal." We are getting rather better now, for we have better allowance of rations, some vegetables occasionally and a greater proportion, though still scanty, of fresh meat. The French, by taking the right, have diminished the labours of our men, who had dwindled down to a number totally inadequate to the work. Some few huts have been erected, also, and on the whole things are "looking up" as they say in the markets. But nos numerus sumus-we are now a mere handful. Out of my own poor remnant of a regiment I have already this month sent 100 invalids away, and I have this day sixty-four sick in the field hospital, chiefly scorbutic affections. We have less of the fearful mental and bodily prostration than we had during January-such cases of utter degradation of the visvitce as we had during that month I trust I may never witness again-I never read or heard, much less witnessed, anything approaching to it.
Gen. Sir. G. Brown has joined us again-to my regret-for though a bulldog in courage, he refers everything to the Peninsula standard, and wants all the qualities I consider most essential to a good general officer. He always stood in the way of every sanitary improvement in Bulgaria. I cannot give you a better illustration of his character than the following anecdote: -He was wounded in the arm on November 5, and has since been away from camp, either on board ship or at Malta. He saw the regiment three days ago, and about the first question he asked our commanding officer was whether he had pipeclay 1 The major in command replied that he had not, and on further enquiry, that there Was none to be got at Balaklava.
"Well," said Sir George, "it must be got from England, get your belts clean, then the men will think of cleaning themselves." Not a word about the means of ablution and personal cleanliness-one of our greatest difficulties. Our only water is got from very small streams issuing out of springs in the ravines. The men bring with great labour enough for cooking up to camp. From only one set of flannels having been issued to the men until lately, when a second set was given, from their constant labour~ utter fatigue and prostration, and always lying on the muddy ground, their underclothing became infested with a species of vermin, different in some respects from the ordinary pediculus; they multiplied in immense numbers, and the more anmmiated and prostrate the man, the greater the increase of the parasites. We have done all we could to arrest the evil, but without washing tubs, bathing place, drying place, with snow on the ground, and no protection but a tent, it has been impossible to prevent it altogether. Men threw away their flannels, abandoning all hope of ridding them of their swarms. You would not credit it, if I were to· describe what living tissues I have seen some of these woollens become. Very few officers were at one time, before we got our baggage from the transports, free from some of these companions; and even at this moment no means are arranged for washing even our hospital blankets. I long since suggested the conversion of two houses 01' sheds at Balaklava-one into an ablution, the other into a drying house, for hospital blankets, &c.-but nothing was done. One of our great difficulties is still to obtain for the men the time and means of personal cleanliness; Sir George Brown proposes to effect this object by pipeclaying the belts and appearing clean-perhaps the reality of cleanliness may follow.
Remember me to Mr. Cock-Callaway and my other friends at Guy's. Watt also desires to be very kindly remembered.
Very truly yours, (Sd.) THOS. LONGMORE.
P.S.-I am sorry to say you will have to pay postage for this scribble as I cannot get stamps-the post-office has no heads; the other departments seem to be no better off.
Letter from Dr. WATT, Royal Welsh Fusiliers. Camp before Sebastopol,
February 3, 1855.
SIR,-Having observed that the 33rd Regiment sent away upwards of twenty sick yesterday on the baggage horses of the regiment, I have the honour to request that you will be pleased to obtain the sanction of Dr. Hall, the Inspector General, for my being allowed also to send away my sick, who are able to bear removal, in a similar manner.
I would call your attention to the enormous amount of mortality (runety-four deaths) which has occurred in my regiment during the past month. I need not say how much the presence of such an amount of disease must infect the healthy men. I have not room in my hospital for all the cases requiring treatment, and many men have died in their tents during the past month. The 7th Fusiliers have during the month sent away about seventy men in the same way as the 33rd' Regiment, and I am of opinion that if I had been able to send away men when first' affected by disease, that very many lives now lost would have been saved.
I would also advert to the almost entire absence of medicines which, as you are aware, exists. With the exception of opium, sulphuric acid and turpentine, I still am without any astringents, and many medicines I consider indispensably necessary for the treatment of dysentery and diarrhma are also wanting. I have not tried the treatment by means of charcoal which was so kindly suggested by Dr. Hall, as I have never seen it used in dysentery, and in reference to the books in my possession, I cannot find any description as to the manner' in which it is desirable it should be used. I should feel much indebted if I could be informed how this remedy should be given, as in the present dearth of medicines any addition to our supply would be a great boon.
Dr. ALEXANDER,
I have the honour to be, Sir, Your obedient humble servant,
(Sd.) W. G. WATT, Surgeon R. W. Fusiliers.
Deputy Inspector Gen. of Hospitals, &c., &c., In Charge-Light Division.
My DEAR BIRKETT,-I received your letter of the 9th inst. to-day. I write a hasty line to let you know that I have sent you two packages of the veritable Crimean pediculi. I don't know whether they will survive the voyage, but perhaps they may, and they may then be of some interest perhaps as evidence before Mr. Roebuck's committee. They are not likely to multiply and spread among you clean people in London, as they seem especially engendered by dirt and neglect. They infest the woollen clothes first, afterwards the person, and have no particular fondness for those parts of the body covered with hair. (When a man has had the head, &c., infested with vermin, as well as, the clothes, the lice have been distinct in species.)
The lice so much talked about in the Crimea are of the same family, I believe, as those which infested our troops in the Peninsular-at least an old Peninsular officer told me so. The pediculi I send you were as common and seemed to thrive nearly as well on the ground for some time as on the clothes, and the officers, who had to lie down in the trenches where also the men were in the habit of lying, got them in this way in considerable numbers every time they went on duty in the trenches. They multiplied with marvellous rapidity in the clothes and persons of men who became anremiated and, much debilitated-and the increase of vermin, and increase of debility, by mutual co-action, went on at last at geometrical ratio until death carried off the man. Putting out flannels for a couple of days in snow destroyed the lice, but not the ova, and it was very difficult to get rid of them as we had no means of boiling' or baking the clothes. The larger lice burst from the effect of the cold when placed in snow, others became shrivelled up.
Here is 'an epistle on rather a curious subject, and you should have witnessed the surprise of a military friend of mine who took up one of the small parcels directed to you when I announced to him the contents.
The pediculi when packed up were alive and seemingly thriving, they are still tenants of their native flannel, and are stowed away not so tightly as to interfere with their comfort
in two empty match boxes. To obviate any chance of escape, I have carefully pasted them up with a covering of white paper, more particularly out of consideration to \Vatt, who is the bearer of them to you.
Believe me, Very truly yours,
(Sd.) THos. LONGMORE.
[EXTRACT.] Oamp before Sebastopol,
April 1, 1855. You fancy we army doctors have much more
power than we have. The use of the stiff stock has been remonstrated against for years-was particularly objected to in Bulgaria-and common sense as well as physiology oppose its use. It may be useful to old men to support the head-the Duke of Wellington was compelled to wear several stiff rollers round his neck of late years with this object, but it is most objectionable for troops on the march or engaged in active exertion'- But what avails one writing or speaking 1 Sir G. Brown has ordered the commanding officers of his division to procure them for the men immediately, and I presume if you enquire of the Army clothiers you will find they have been sent and are already on their way to us. So with the chakos -they are to be restored at once, and the men who have lost them are to pay for new ones~rather a hard case, for they were ordered not to wear them in the early part of the winter, as the height and brass ornaments made them conspicuous objects for the enemy's riflemen when they went into the trenches. They had no place to put them, and usually stuck them on their arms as they were piled in front of the tents. The wind took some, and from various reasons in the end all were lost .
. The French leave their chakos at home, and bring into the field a neat, light and easy casquette. But all this will be remedied by-and-bye, I suppose.
Oamp above Sebastopol. April 30, 1855.
My DEAR BIRKETT,-You good people at home are treating us regimental surgeons very cruelly. You are establishing civil hospital after civil hospital, sending out men at immense
Lette1'S jl'0111 (the late) Sir '-rlwmas Longmore 365.
salaries, and stopping that which is the only prospect of advantage open to us-our promotion. No distinction; let a man be able to afford proof of having done his duty, it is all the same, the civil surgeon comes and bars his progress. And look at the disproportionate compensation. There is now stopping with us a very young man-a brother of one of our officersof the name of Rooke. He is assistant surgeon in the Dreadnought, and that berth is to be kept for him till his return. His expenses have been paid out here-he gets £2 2s. a day-field officer's allowance--and is to have a year's salary given to him when he leaves. Look at the salaries of the medical officers in the civil hospitals at Smyrna and on the Bosphorus. Dr. Lyon with "a liberal outfit, travelling expenses, £100 per month, and a year's salary on leaving," to make autopsies and report (jn prevailing diseases. So says the .Medical Times, and more civil hospihls are to be established. Look, on the other side, at a regimental surgeon like myself, and after twelve years' service, of which six have been abroad, not including the present campaign in Turkey and Crimeatwo of those years in some of the worst parts of the West Indies-I am getting 13s. a day, minus income tax, regimental deductions, and less allowances than a captain in charge of a company. All the risks of the campaign with none of its honours and advantages-not even the chance of promotion now. It is true that after twenty-five years' service I may get a retirement of 13s. or 15s. a day, but is that adequate as compared with the chances of my not reaching that period of service?
I admit fully all the shortcomings at Scutari and in the field, but depend upon it the medical officers for the most part have not been to blame. You are not punishing the right parties, and never will. I fear-so much power and influence are against it.
Dr. Davy, whose name was mentioned in the House of Commons th{J other night, in a letter to me some time since, asked if I had kept notes on certain subjects. 1 have transscribed for his perusal some of my letters to the military and medical authorities, of which I have fortunately kept copies, to show that I have not been blind to the numerous causes of disease which we had no means of averting, and which I
am sure no civil surgeon under similar circumstances could have either averted or counteracted. I should like you to look through them if you have time, and when you have done so, wiU you be good enough to post them to Dr. Davy's address, which I will enclose 1 I have not time to make a copy for you, or would do so. I suspect you would find, if you had. the opportunity of doing so, that there have been very few Guy's men out here who have not been not only fully alive to the evils the Army was subjected to, but also independent enough to do all they could do-namely, to represent and expostulate in the proper· quarter.
Believe me, Very truly yours,
(Sd.) THOMAS LONGMORE.
[EXTiACT.] Camp Sebastopol,
October 4, 1855.
I sent away five invalids to-day to England, Chatham, I suppose. I will send you notes of one or two
. of the cases next mail. I have had twenty-four documents to write out with these five men! One for all practical purposes should have been enough.
Camp Sebastopol, February 12, 1856.
I hope the new warrant will do something for the assistant surgeons as well as all of us. They have lately sent out uneducated dispensers, without any diploma-mere dl.'uggists' boys-and given them the same pay and allowances as assistant surgeonfl, with the only difference, indeed, that they rank as ensigns instead of lieutenants.
Camp Sebastopol, November 14, 1855.
December 1, 1855.
My DEAR BIRKETT,- . The fearful explosion has stopped my doing anything further. I will try and send you Green's case next mail. We are close to the siege train. I was knocked over as I sat writing at my table, the roof of my hut wrenched up, a skylight window driven in, door
knocked off the hinges. A shell must have burst just over my head, for the fragments fell on both sides of the hut, and one large piece struck the wall. The uncertainty of what had happened, and was happening, was very awful; it seemed as if the whole ground has been undermined, and the Russians were blowing us all up together. One piece of shell went through my servant's tent close at hand, another went through. my stable. Another shell knocked part of the roof of my hospital kitchen away, a shot went through one of the hospital tents, every pane of glass was broken, and the roof of one of the hospital huts was lifted up-yet only one man at the hospital was struck, and he not hurt seriously. Most of my regiment were fortunately out of camp. Had the English powder-mill blown up there would have been no escape for us.
Believe me, very truly yours, (Sd.) THos. LONGMORE.
Oamp Seba8topol, January 14.' 1856.
February 26, 1856.
My DEAR BIRKETT,-. I thought over the remarks in your last about the Professorship of Military Surgery. Perhaps a few words from an army doctor might be useful in one of your London publications on the subject. I'll therefore sketch out a few lines in reply to your remarks. If you think them worth sending, send them as written to yourself.
I quite agree in what you write about "Lectures on Military Surgery." A course of lectures on Military Surgery, using the word in its strict sense, cannot be required in a school where a chair of surgery already exists; for the science of surgery admits of no speciality; its essential principles must be identical in all places, and under all circumstances. But yet I think it right to have a distinct course of lectures for army surgeons, in addition to the general courses on surgery and medicine, in the Metropolis. They ought not to be called "Lectures on Military Surgery": such a term serves only to mislead. I cannot suggest a phrase comprehending in its meaning the full nature of the subjects which should be embraced in this course of instruction. The term "Military Sanitation" comes nearest to it to my mind; for M ilitum de 8anitate tuenda must be
the topic of the Lecturer's discourse, in all its parts and bearings, and the word Sanitation will equally refer to organic and physical soundness-to things medical and things surgical. Some new term is required to include all the considerations which ought to enter into the mind of a military medical officer, arising from the peculiar duties, habits and circumstances of soldiers, and in reference to the diseases and injuries to which they are especially liable. A military surgeon has much to learn, although he may have studied diligently at hospital, and gained his diplomas of medicine and surgery. The civil life, the attention and habits of thought, are directed more particularly to the diseases of the home climate, and the circumstances of a highly civilised community. Another train of mind is necessary for the army surgeon, who may at one period be treating his patient in the Tropics, at another in a region of excessive cold, such as certain parts of North America; at one time in the life of march, at another on board ship; now in a make-shift cantonment, now in a camp; in a friendly country, or before the enemy. Circumstances connected with transport, means of attention, opportunities of after-treatment, modify military practice; and what might be a judicious surgical proceeding in civil life, might be very injudicious in the field. The adjoined extra-professional duties of the military surgeon are a study in themselves. The rules of the service. the exigencies of military discipline, the mode of carrying on the medical duties, the administration of hospital affairs varying in different colonies, the complicated connections of the medical with the other departments of the army, have to be learned and acquired. I have often experienced myself, and observed in others, the delay and difficulties arising from deficient information in some of these respects. The preliminary month or two spent at Chatham only gives the opportunity of learning, or at least used to do so, the formal mode of keeping registers, examining recruits, and a few routine duties. "Each officer, therefore, gaining his knowledge by personal experience, learns by degrees what meets him in the accidental sphere of his employment, and occasionally commits blunders when brought into new situations from want of a more extended knowledge and direction. An initiatory exposition of all these matters would render the tyro independent of acquiring an insight
into the army medical economy by the slow, and oftentimes expensive, lessons of experience. Many mistakes and much correspondence would be avoided; knowing all that had been done already, he would be in a better condition to advance and improve. It would be the Professor's duty to keep pace with the progress of the time, and to explain to his class the changes which are daily occurring in the rules' and regulations of the military service. It would be his duty, too, to point out the improvements in civil practice. Such a course as I speak of, to be really valuable, should be given at the headquarters of the Army Hospital establishments, where all the stages in the career of the soldier could be observed, from the examination of recruits, to the final discharge of the worn out and invalided. This is carried out in perfection at the Val de Grace in Paris,. where, from the completeness of the system, the lectures and demonstrations are nearly as beneficial to the advanced military surgeon returning from his tour of colonial service, as to the younger one just entering the profession.
There is another point of view from which the military medical officer should be regarded. He is a veritable sanitary commISSIOner. His province is as much to prevent disease as to cure it. He has to search out and neutralise its sources, to arrest its progress when an outbreak occurs. In civil life the surgeon or physician treats the cases in which his advice may be asked; it is the duty of others to perform the offices I have just mentioned. Soldiers require constant watching, for their own sakes as well as for that of the country· at whose cost they are maintained. Few of them have the necessary knowledge or care, even of self-preservation, beyond the common animal instincts; none of them have any knowledge of themany essentials to be attended to in order to ensure a general safety when they are herded together in masses. Even intel~
ligent military officers who have not thought on this particula1,' subject, often hold very limited· or mistaken ideas respecting it, and I believe it would be for the benefit of the troops if the medical officers had more direct influence than they have in matters of sanitary influence. I know, during one campaign, at least, that in one division of the Army, no medical officers were consulted with regard to the arrangements of the encampments and other points, when suggestions, such as ordinary
370 Lettertos from (the late) Sir (Phomas Longmmoe
sanitary science would have dictated, might have been of vital importance.
I think I have written enough to show you that military surgeons do absolutely require a course of teaching and study, after they have become familiar with lectures on surgery, and surgical practice at a civil hospital, and even after they have become members of a College of Surgeons; but it is certainly a misnomer to give to such a course the inexplicit title of "Military Surgery." The particular considerations connected with the military practice of surgery can only form but a limited section of the course.
There, will the above suggest any epistolary comments from yourself in the form of a letter to one of your journals? I suppose many would say that the term hygiene-is that the way to spell it in English ?-would be significant enough. It is not, however, to my fancy, because, although meaning preservation of health, it would not include the physical partyour gunshot wounds, &c. If you write anything about it let me see it.
Our amputating knives are packed up for the present, and the ~tethoscope is in the ascendant, catarrhs, bronchitis and pneumonias are the order of the day. Coups d'air, as the French call them, and leakage, in the expensive but ill-fitted huts sent out,. and bad boots, are the apparent causes. The men are so well fed and clothed, and consequently in such good condition, that the mortality is very limited. The French a few weeks since were very badly off-they are better now. They have had a great number of frost bites, much bowel complaint and scorbutic affection. What a bustle there will be when our winter quarters are to be abandoned. Balaklava given up-the large town of Kadikoi and its minor dependencies, Petit Kamiesch and Donough Brook quitted, the rails pulled up, &c., &c. Do the merchants still talk of peace in your parts?
