affairs, to be formulated by an unreformed clerical convocation, while reserving to itself merely the opportunity of saying yes or no, once for all, to any scheme of Church membership and government which this Convocation might propose to it.

Under these circumstances our reformers of Convocation might do well to consider the wisdom of endeavouring first of all to arrive at a distinct understanding as to the position and powers of laymen in the counsels of an autonomous Church, which would be accepted by the Houses of Parliament. And, seeing that the true method in all reform is to effect the required improvements with the minimum of change or friction, might it not be a sound and wise policy to propose at the outset that the lay assembly in the Church's Parliament or Convocation shall consist of all those lay members of the House of Lords and all those members of the House of Commons who claim to be members of the Church of England as by law established?

But my primary objection to our relying on these two measures as healing measures for immediate application is that they cannot be got ready for immediate and healing use.

Assuming their virtues to be all that their respective supporters believe them to be, what hope is there of applying them in time to give the patient the desired relief? To such a question there can, as I venture to think, be only one answer. There is very little prospect of passing either of these measures and putting it into successful operation without a long and bitter conflict, and even possibly a conflict that might involve some trouble to governments.

Can the Church afford to wait for the issue of such conflicts in the political arena, and to risk the dangers involved in them? My plea is, that, all the signs of the times being duly considered, such waiting might prove too perilous.

It is conceivable that masterly inactivity, or debates in Parliament and Convocation long drawn out, might represent a wise policy, if we were safely entrenched on terra firma; but for those who are afloat in a vessel amid strong currents which might all too easily sweep it in the direction of a cataract, to persist in sitting with folded hands, or spend all their energies on interminable disputes, is suggestive of that spirit of blindness or over-confidence which is close akin to infatuation.

Looking, then, to the present circumstances of our Church, her needs and her dangers, I put it forward with all respect as my firm conviction that any influential body of Churchmen who would throw the weight of their influence into a united effort to carry with as little delay as possible such a measure of reform as I have here indicated, would be doing a great deal to save us from some grave and threatening perils, and would deserve the gratitude of both Church and Nation.

J. HEREFORD.

THE SOUTH AFRICAN HOSPITALS

COMMISSION

THE elaborate report of the Royal Commission upon the care and treatment of the sick and wounded during the South African campaign' resolves itself into two distinct divisions. The one of these is concerned with an inquiry into the many serious complaints made as to the care of the sick and wounded, and the other with recommendations for the remedying of certain defects in the Army medical service.

The body of the report will be read with considerable relief, and with a degree of satisfaction. The inquiry undertaken by the Commission has been arduous and far-reaching, has involved the handling of an immense mass of evidence, and the investigation of charges which have lacked little in the way of either variety or virulence.

It is satisfactory to find that the graver of the charges made have proved to be either exaggerated or unfounded, and that the medical service of the Army can claim to rise from the ordeal with distinct credit.

The findings of the Commission will carry with them conviction, for it is abundantly evident that the inquiry has been conducted with infinite patience, with thoroughness, with impartiality, and with admirable judgment.

The general result of the investigation is summed up in the concluding passage of the Report, and in the following words:

We desire to say that, in our judgment, reviewing the campaign as a whole, it has not been one where it can properly be said that the medical and hospital arrangements have broken down. There has been nothing in the nature of a scandal with regard to the care of the sick and wounded; no general or widespread neglect of patients, no indifference to their suffering. And all witnesses of experience in other wars are practically unanimous in the view that, taking it all in all, in no campaign have the sick and wounded been so well looked after as they have been in this.

The more detailed analysis of the evidence makes it clear that the strain thrown upon the Army medical service was very severe, and that on occasion the demands were so sudden and excessive that they could not be satisfactorily met by the department. Those who read the report cannot fail to find themselves more in sympathy with the Royal Army Medical Corps, for the matter-of-fact account which is given shows vividly the immense difficulties the department had to face, and furnishes details as to the overpowering crowd of sick

and wounded who flocked to the hospital tents. The report itself is sympathetic; and it is apparent from many of the comments made that the Commissioners fully appreciate the hard case of the worried and overworked medical officer who had to deal with emergencies which no forethought could have anticipated, had to wait always upon the fortunes of an overburdened transport, and had constantly to attempt the problem of making bricks without straw.' The report, moreover, brings forcibly into notice the fact that in war there is cast upon the sick and wounded an immense amount of needless suffering and misery. The fact is lamentable enough, and the Commissioners are compelled to acknowledge that no little of this distress would seem to be unavoidable and beyond remedy. In this admission there is no attempt to hide incompetency and unpreparedness under the platitude that war is war,' nor are the results of inefficiency improperly shielded by the general cloak of the 'horrors of war.' Speaking of the state of the wounded in the advance to Kimberley, the Commissioners have to own that 'the suffering occasioned was part of the price that had to be paid for success in the campaign.' Over and over again in the report this remark is re-echoed.

The finding of the Commissioners upon the very numerous complaints brought before them need not be discussed in this place; but the following incidental matters in the substance of the report are of some importance and interest. The number of individuals under the control of the Army Medical Department may be gathered from the following paragraph: At the time of the greatest pressure, which occurred at the end of the month of March, the total force then engaged being about 207,000 men, there were about 800 medical officers (including civil surgeons), 6,000 hospital subordinates, and 800 nurses in the country.'

The Commissioners' opinion of the Royal Army Medical Corps and the civil surgeons is thus expressed:

Like every large body of men, the Royal Army Medical Corps has its unfit or bad members, but the evidence justifies us in saying that, in this war, the proportion of such members to the whole body of the Royal Army Medical Corps is very small. Speaking of the officers as a whole, their conduct and capacity deserve great praise. Their devotion to their duties, both at the front and in the fixed hospitals, and the unselfish way in which they have attended to the sick and wounded, often at the risk of life, have been recognised by all impartial witnesses. The civil surgeons employed in this campaign have, as a body, done their duty extremely well. But few complaints have been made against any of them, and such complaints as have been made are not of a grave character. As a rule, the civil surgeons worked well with the officers of the Army Medical Department.

The much-abused orderlies are commented upon in these words: Many orderlies displayed great devotion towards their patients and lost their lives in the faithful discharge of their work. The complaints against the orderlies are no doubt due, to a great extent, to the fact that the supply of trained men of

the Army Medical Corps was greatly insufficient for the war, and that orderlies not properly trained or constituted for the work had to be supplied. . . . Some orderlies have been inattentive and some rough, others have occasionally been intoxicated, and a few are even said to have been brutal to their patients.

Of the nurses they speak highly, and point out that 'there was no difficulty found in obtaining a sufficient number of suitable persons, nearly all of whom were properly trained.'

A very detailed account is given of the work of the medical department on the various lines of advance, and the description is sufficiently ample to enable the casual reader to form an opinion of the difficulties to be faced and of the manner in which they were met. It is, perhaps, needless to say that the Commissioners are not entirely satisfied with the condition of medical affairs as laid bare by the evidence they collected. They have found certain complaints to be well founded. They draw attention to 'mistakes and oversights on the part of the responsible authorities.' And they conclude their report, as already stated, by discussing what steps ought to be taken with a view of remedying the evils they have noticed,' and they add that 'those evils were serious and ought not to be minimised.'

This brings us to the second division of the report—to the suggestions made with a view of remedying defects. To this portion of the report the greatest interest must attach. That there is much to be put right in the administration of the medical service admits of no question, and the most enthusiastic admirer of the Royal Army Medical Corps must confess that the department is not only capable of improvement, but is in great need of it. That part of the report which deals with the remedying of defects will be perused by many with no little disappointment. The recommendations are few and indefinite, and will, I think, hardly satisfy those who are tolerant of some reform on the one hand, or eager for a large measure of change on the other. It is only fair, however, to state that the terms of the appointment of the Commission did not go beyond the order to consider and report upon the care and treatment of the sick and wounded during the South African campaign.'

Minor recommendations of the Commissioners deal with the improvement of the existing ambulance waggon, the selection of hospital tents, the control of the Royal Army Medical Corps in the matter of supplies, and with administrative details of a comparatively unimportant nature. The principal suggestions come under the following heads:

(1) The establishment of the staff of officers and orderlies of the Royal Army Medical Corps and its equipment on a scale sufficient to enable it to discharge adequately the duties ordinarily cast upon it in times of peace, and by the smaller wars in which the Empire, by its vast extent, is so frequently engaged.

(2) Regulations and provisions which will enable surgeons and trained orderlies in sufficient numbers to be rapidly obtained and added to the ordinary staff of the Royal Army Medical Corps in the event of a great war, and that will also ensure

a rapid supply of all hospital and other equipment required for the due care of the sick and wounded in such a war.

(3) The attraction to the Royal Army Medical Corps of a sufficient and regular supply of officers of good professional attainments, and the improvement of the position of the officers by the allowance of sufficient holidays, and by provisions enabling them to become adequately acquainted with the advancements in medical and surgical science, and the necessity of employing in the higher posts men selected for their merits rather than by seniority.

(4) The employment, to a greater extent than that recognised and practised until the later stages of this war, of nurses in fixed hospitals for the care of the wounded and of fever and dysenteric patients, and such others as can properly be nursed by females.

(5) The appointment of properly qualified officers of the Royal Army Medical Corps to undertake sanitary duties.

Before, however, such questions as these can be discussed it is essential that the position of the Army Medical Department in the scheme of the Army should be more satisfactorily defined. The reading of the body of the report would make it appear that the time has come when the medical service should occupy a far more prominent position as a detail of the Army than it at present holds. In the prosecution of a war the primary object is, without doubt, to effect the purpose upon which the institution of the war was based ; and it is equally obvious that the secondary object is to effect that end with as little loss of life to the forces concerned as is possible. This war, like others, has shown that, in a long campaign, the loss of life from disease is unfortunately greater than is the loss from wounds; and when it is recognised that the larger proportion of these deaths from disease are due to what are termed preventable affections, the importance of the medical department of an army becomes very strongly emphasised. There is a disposition-due in some degree to the subordinate position occupied by the medical service to consider that war is represented only by attacks on trenches and gun positions, and to disregard strongholds and ambuscades of dysentery and fever.

In the returns of the present war, as published at the end of January, the following figures are to be noticed :

TOTAL REPORT UP TO, AND INCLUDING, THE MONTH OF JANUARY