LMITransactions&Report2014-15

LMI Transactions and Report 2014 - 2015
generated lack of supplies and prolonged casualty
evacuation to base facilities, with the added risk of
interruption by enemy action. Casualty evacuation
was more difficult during advances or retreats.
Operations also generated new varieties of medical
problems such as shell-shock and gas poisoning on the
Western Front. There was little shell-shock in
Mesopotamia. Relationships with the local population
could be hostile in Mesopotamia and it was always
important to negotiate with the locals.
Geographical factors played a major role. The
prevalence of diseases such as typhoid in the local
civilian population and in animal reservoirs would
influence the likelihood of infecting the soldiers.
There were problems of heat stroke in the Dardanelles
and Mesopotamia, and of frost bite in France. The
terrain in France was flat and there was a pre-existing
infrastructure of roads and railways, although
flooding, wind, snow and ice could be problems.
Casualties in the Dardanelles were evacuated under
fire to poorly-organised medical facilities. Although
these improved compared with the second wave of
landings, there was no space in the bridgeheads and a
lack of resources for anything like what was available
on the Western Front. In Mesopotamia there were no
railways and few roads. Transport was by horse- or
donkey-drawn vehicles over very long distances, until
a river could be reached.
To some extent, technology played a part in ironing
out the differences between the 3 theatres. In
particular, immunisation against typhoid and tetanus
was available in all 3 areas, but immunisation against
cholera was only 50% effective. Each theatre
presented its own unique challenges, but the
difficulties remained greatest outside Europe.
Geographical difficulties could be partly overcome
given sufficient planning and resources.
Operational factors always played a major role. For
the medical services, the relatively static theatre on the
Western Front carried major advantages, allowing
facilities to be built up over a period. Combined
operations such as in the Dardanelles added problems,
with poor communications and rivalry between the
army and navy. When warfare was more widespread,
such as in Mesopotamia, the extended lines of
communication stretching over thousands of miles
With the rising tide of nationhood in the British Empire
it was important that Imperial troops were seen to be
treated fairly. On each side of the conflict, nations
accused each other of poor treatment of prisoners.
Relationships between commanding officers and
medical officers was crucial. The Medical Act of 1858
increased the professionalisation of medicine and the
Royal Army Medical Corps was founded in 1898, giving
medical officers the same ranks as the rest of the army.
However, relations remained strained in the later part
of the Victorian era. In the Boer War the senior
commanders such as Lord Roberts and Sir Garnet
Wolseley had a poor opinion of medical officers and
this view appeared to pass down the chain of
command. There was a great gulf between combatant
officers and medical officers and operational plans
were drawn up without consultation with medical
officers. Advice on water purification, sanitation and
rations was ignored, resulting in 8000 deaths from
typhoid. Consequently public support for the war
declined.
After the Boer War, lessons were learnt. There was
better training of commanding officers in the
importance of hygiene and sanitation. It was thought
that better Japanese medical services had contributed
to their victory in the Russo-Japanese War. The
efficiency and status of the army medical services were
built up by Lieutenant General Sir Alfred Keogh, who
was Director General 1904-1910 and 1914-1918. He
worked well with Lieutenant General Sir Arthur
Sloggett who was in charge of medical services on the
Western Front. Although the rapid expansion of the
army diluted knowledge and caused a relative lack of
training, every effort was made to overcome this. The
High Command on the Western Front was acutely
aware of the connection between good medical
services and morale and the need to provide good
facilities to get soldiers back to their units as soon as
possible.
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