'\U
Oct.,
STAFF TOURS AND THEIR USES.
1911.
(Oriqinnl
/
STAFF TOURS AND THEIR USES.
LIEUT.-COL.,
(Ed.),
I.M.S.
or Staff rides consist in workground without troops strategical and problems, and problems in staff duties?the com-
Definition.?Staff tours
ing
out on the
tactical
manders, staff and heads of administrative services represented by officers ; the troops and impedimenta
are are
The director in-chief prepares a scheme of the operations with general ami special ideas upon which the work of the staff four is based. Object.?The object of staff tours is to train higher who may be commanders, staff officers, and those * appointed to command or to the staff Instructions relative to the mode of locomotion, hour, date, and place of assembly, dress to be worn, arrangements regarding camp and messing, books and stationery required, postal arrangements, and other details are issued to those taking part in the staff tour some days before it begins. Other preliminary requirements are ths preparation of a scheme, appointment of a directing staff, and selection of officers to attend. Officers representing all branches of the military service are selected for staff tours, including?directorin-chief with two directors in largo staff tours, or director with two assistant directors in smaller 01109; general officers commanding the opposing forces, or one general officer commanding if only one force is represented, each with three or more general staff officers; A. A. G., A. Q. M. G., P. M. O. of the force, P. M. O.'s of divisions, S. M. O.'s of Brigades, 0. C.'s Geld ambulancesf and Sanitary Officer ; C. II E ; 0 C. mounted troops; O. C. artillery; Brigadiers, each with his
imaginary.
?
brigade major
; camp
commandant,
etc.
The director in-chief or director is appointed to conduct the instruction of officers attending the tour. For a double staff tour the director-in-chief adjudicates between the opposing forces. He controls the course of the staff tour by instructions issued to the directors of the two sides When the number of officers is large, the officers are subdivided into parties of 5 or 6 each under an officer of the directing staff. A camp commandant accompanies the tour or two He arranges about the when there are opposing sides encampment of the officers, messing, transport of
luggage,
etc.
The length of time occupied in staff tours for formations up to and including a division seldom exceeds four days, exclusive of the day of assembly and day of departure, and exclusive of the preparatory work with the appreciation, for smaller bodies of tro
? 110).
If the position fixed for the dressing stations of bearer-companies is at a distance from the firing line. collective) stations will be fixed as the action progresses, If the dressing station is close at hand, or reasonably near the fighting line, the establishment of collecting
stations is unnecessary ; the wounded are then taken direct to the dressing station from the fighting line. If the dressing stations are at a distance, then the woinded from the fighting line are brought (or find their way) to the collecting station and taken from there by the bearer-company men to the dressing station under the care of a medical subordinate. Medical officers with the authorised equipment remain with the dressing stations (both equipment and personnel bring reinforced when necessary). If there is no building or huts available, a tent is pitched. Ambulance tongas (if roads permit) otv animal transport and dandies* will rendezvous at dressii g stations to carry cases from them to the field ambulances. In selecting sites for dressing stations of bearercompanies divisional P. M. O.'s, and brigades. M.O.'s should remember that the infantry fire of the present day may be effective at a distance of 2,COO yards and makes an advance against it at anything closer than 1,000 yards inseparable from severe losses. They have likewise to consider that present-day artillery fire may be seriously effective at over 5,000 yards (even at 6,500 yaids), and at 4,000yards an advance in close formation against it is considered impracticable ; hence the wide extensions of infantry now adopted, which, amongst other advantages, gives more opportunity for men to take ewer.
Returning hospital trains are utilised to bring medical personnel and materiel towards the front. t The mobilisation and opening of general hospitals is most essential and should be the first in all field
P M. O of the force with regard to Sick and Wounded.?The P. M. O. of the force must be thoroughly familiar with the military situation, and especially with the conof the sick and ditions affecting the evacuation wounded. There are many conditions affecting this evacuation, such as the number of beds available in the field ambulances, extent to which further evacuation is possible, whether the line of evacuation is open, interrupted or blocked ; or whether an unlimited number may be evacuated. He must know along what
may nave to be
tongas.
station. *
steps medical organisation on a large scale; they should be brought into existence before the troops concentrate at the base. In them everything should be as perfect for the care and treatment of the sick and wounded as in any large hospital in India. I Hospital ships are usually arranged as accommodation, berths, etc., specially for sick andregards wounded, but any empty transport vessels returning from the seat of war
improvised
for the use of these patients.
Duties of the Evacuating the
*
Dandies and riding animals are alternative to ambulance The former are only used where wheeled traffic is
impracticable.
evacuation is to be adopted?by road, mil or if by road, length of the journey, whether suitable for ambulance tongas and supply wagons, and the arrangements for the journey; the transport to be used for the sick and wounded ordinary ambulance tongas, supply wagons, country carts, ponies, mule3, camels, dandies, and the exact number of eacli of these available. No evacuation is, of course, needed for the very slightly wounded or those very dangerously wounded. The periods of inactivity are to be employed in medical officers, medical subordinates, and routea
river;
training
field ambulances, erecting, striking, of field ambulance camps, preparing surgical tents for immediate use, arrangements for the reception of full number of wounded, inquiring into arrangements for those that will be left behind, and ascartaining the extent of local resources. Preparations for fighting that, is expected within a definite period include a knowledge of where all the reserve field ambulances are, at what distances in the rear they are, and making arrangements for lliem to reinforce the field army should this be necessary. Before an action field ambulances with the force are usually cleared of such sick and wounded f.s can be removed to the rear with safety, and all arrangements made for the riception of casualties from the field If a field ambulance, from the number of sick and wounded it contains, want of transport or other reasons, cannot be moved, its place in the division is to be taken temporarily by another field ambulance moved up from the reserve or the liueof communications. The ordinary routine throughout a campaign is that all sick and wounded, except trivial cases with the field army, are passed on towards the base as soon as practicable. Diese proceed with sick convoys, in charge of a medical officer or mtdical subordinate, with a N C. 0. and guard in charge of arms and ammunition, and are handed over at the next camp or billet on the line of communications, the transport, guard, and medical personnel returning to the field army. Further similarconvoys on the line of communications convey them to the base or rail head. The normal position of field ambulances in a camp is in r?ar of the centre of the force to which it belongs. If buildings are not used, field ambulances are pitched according to the plan laid down in Indian appendix to Combined Training. In a forward move when fighting is expected, the normal position of field ambulances is in rear of the ammunition column, but the G. O. C. of the force may consider it necessary to locate them immediately in rear of the fighting troops, or at a fixed distance behind the second line of transport In selecting sites for field ambulances b?fore an action, care is to be taken that the position is as neir the dressing station as the military conditions permit, and that there is a practicable road for ambulances from the front and a sufficient water-supply in the vicinity, If the position is not visible, direction flags are put up (F. S. M , M., ? 126). On the eve of an engagement efforts should be concentrated to prepare to receive the wounded and "Endeavours evacuate them as early as practicable. uiust always be made to evacuate the wounded for the
establishment
packing
and
following
of
loading
reasons :
1- In the event of an unfavourable issue the wounded must be saved from capture. 2. In the event of victory the area of operations should at least be cleared of the wounded who can be
evacuated, and the medical personnel devoted entirely to the care of those who are still left upon the field,
sometimes in great numbers and under very bad
con-
ditions.
majority of wounded who can be evacuated engagement are men who are fit for transport, seeing that the very seriously wounded are rarely capable of being sent back during the unfavourable condi3.
The
during an
tions of
a
battle, and,
373
IN ACTION.
Oct., 1911.]
as
the
wounded
come
in in
com-
at a time, the medical officers will not be tired out, and will be capable of treating them carefully and getting them fit for transport. 4. Wounded readily disregard the discomfort of transport in view of tlieir desire to get away from an area wliere they are exposed to the dangers and vicissitudes of battle."* As a general principle all the available medical resources of the field army that may be necessary should be pushed up to the battlefield after a victory, iu order to relieve as early as possible the suffering of the wounded who have not as yet been aided. In a planned battle the locality for keeping field ambulances in readiness should be behind the centra and (when practicable) at a spot where roadameet, from which fairly good communication can be maintained with all parts of the field, and which are easily found. Care is naturally taken to guard against selecting a place too far forward in the direction of the enemy, which, iu the event of a retreat, may btcome an impoitant position, and where no risk of blocking the passage of the troops should be run. The time for assembling the field ambulances at the selected spot is to be calculated so as to aV(,id too early a start. Our Regulations state that the will as far as may position of field ambulances (which be considered neceasaiy be pitched ready to receive the M- 0. of the force or wounded), will be fixed by the Pdivision under the orders of the G. O. C. ourselves the exact posiIt ia well for us to picture to field ambulances, dressing tion of the medical personnel, stations and the wounded during immediately after, a few hours after, and the morning following a successful
paratively small numbers
extensive engogement. , The more continued the fighting, the greater the necesthe of at the front. hospitala continred clearing sity for With an advancing army the field ambulances must also the force are encumbered advance and if those with in reserve and at the head (vith sick and wounded, those must take their of the line or lines of communications that the clearing hospital remember should We nhce in future campaigns), (which will probably be introduced head of the lines of and the field ambulances at the communication, are lines of communication hospitals M. Ob. lines of communi* under the orders of the P. O. of the force or of * division M. the P. but cation, where they can be best placed to assist .
may
.
suggest
0. of the force handles an action the P. M. are not attached the field ambulances as divisional ; they are acting independto brigades unless such brigades P M. O. works the Similarly a divisional ently the division ; they are field ambula. ces as part .of lhe P. M. O. of not under the orders of brigadiers, of lie force; the head-quarters with deals force the divisional staff. the with division a of O the P M medical arrangeWe have to bear in mind the varying is not anticipated for ments required when-fighting and expected at once. some time, is shortly expected the question of providing These contingencies afftct and the distribution accommodation for the wounded last-named case, for the In resources. medical of our all things have to be prepared and at hand
'"Soring
example, ready the
moment
fighting begins.
,
.
The different condiiioi'8 of defence, attack, defence of detacln d forces, counter-attacks, or the formation the disof temporary reserves?each of these affects as regards tribution of medical ambulances, especially of the the transport necessary for the evacuation wounded and in the selection of collecting and dressing stations.
t formulated battle
we have to conan attacking engagesider whether it is a defensive or distribution of the medical ment; in the former, the field ambulances is easy and definite and personnel
In
a
planned
or
* Strategical and Tactical Employment of the Medical Service pp. 30, 31. % Lt.-CoL. Maximillian Hiitkk von Hoex, translated by Lt. Col. W, G. Macpiierson, c.m.g.,
r.a.m.c.
THE INDIAN MEDICAL GAZETTE.
374
orders may be issued. In encounter battles no such definite arrangements can be made as regards time and place of distribution of medical personnel and equipment ; which have to depend on the time and place at which the opposing forces advance, and upon the plan of operations which the commanders of the opposing forces settle upon. Outdoor Work.?Medical officers as part of their outdoor work on a stiff tour may be asked to report on the facilities which exist in the neighbouring town or villages for establishing hospitals in them, what supplies there are, what additional medical assistance (if any) can be obtained ; to report on a given site for establishing a field ambulance under canvas, and if not suitable to select another and give reasons for the selection made ; report 011 the condition of the road or roads for wheeled ambulance transport ; select sites for dressing stations for a mixed infantry brigade in action at a particular place ; report on camping grounds and bivouacs for a brigade or a division, the water-supply in close proximity, etc , etc. The P. M. O. of a division may be required to go over a certain area of country to plan out the medical arrangements in the event of an action being fought there. These different outdoor tasks may have nothing to do with the main scheme of the staff tour. " Sketches, tables, diagrams and graphics should be furnisVed in connection with tasks when by so doing the work will gain in clearness and conciseness." It is always necessary to be fully acquainted with the local resources of the localities in and near the theatre of operations?buildings for hospitals, medical and surgic 1 equipment available, food for the sick,
transport,
etc.
In reporting on the resources of a town in India as to its capacity to receive the sick and wounded, etc , the following points deserve atiention. The three chief places to acquire knowledge of the town are?the municipal office, the butchery and the main thana or police station. In addition we should go over the whole town. Ascertain if there are any hospitals and dispensaries ; if so, where they are located, how many cases they can take in?these hospitals could not, of course, be empty at the time. The cases left in them by us would ba treated by the hospital staff, being controlled by us. Find out the existence or not of any other l uildings, institutions, churches, etc., that would be able to take in a certain number of cases, but would need some medical personnel, hospital establishment and equipment. We should examine any existing hotels, boarding houses and serais, that would have beds, bedding and ordinary utensils and some servants, but would require complete medical and nursing staff and equipment. Examine the town hall, markets, schools, etc , which might be able to shelter casualties, but have limited sanitary provisions.
We should also ascertain the number of medical men chemists' shops in the place, and how far these could be drawn upon ; the numbers of vehicles, horses, ponies that could be obtained as ambulance transport ; the amount of coolie labour that could be obtained to supplement the A. B. C. men. Find out also the number of furniture makers, makers of charpoys, iron-mongers, etc., with a viow to purchasing bedsteads and various metal cooking utensils from them in an emergency ; also the local resources for providing temporary latrine, kitchen, and similar accommodation should bo noted. The amount of food and comforts for the sick and wounded should be inquired into?milk, fowl, eggs, sheep, oxen, vegetables, etc.; this is, of course, the work of the S. and T. Corps, but it may fall to a medical oflicer to carry it ouf. The railway station, if there ia one, should be visited to see what facilities it otters for entraining patients, and also to see if a next station could ba established in and medical subordinates and
or near
it..
[Oct.,
1911.
Lastly, a plan of the place should be obtained, and ail the places mentioned marked on it, or if unable to get a plan, one should make a rough sketch of the town and places named. Writing Orders.?One of the most important and difficult parts of a staff tcur is that of writing orders. To do this correctly requires considerable practice and much thought. In this connection it is well to previously study F. S. R.t Part I, Operations, 1909, Chap. II, pp. 18-29, King's Regulations on the same subject, and F. S. M, J/./pp 26?28. The orders a P. M. O. of the force writes are draft orders for insertion in headquarters operation orders, and orders to P M. O.'s of divisions and independent brigades. The orders a P. M. O. of a division writes are draft orders for insertion in divisional opeiation orders and orders to O C.'s field ambulances, and, if necessary, to M. O.'s of corps uuits. The operation orders should only contain the infoimation on medical matters that everybody requires to know. For example, witli regard to an ensuing action, a draft order such as tlie following may be necessary :? ''No Indian Field British Field Ambulance, No Ambulance will receive casualties from Brigade Division," etc. " They will occupy the following position : No No British Field Ambulance at " Indian Field Ambulance at (naming ? village, copse, bridge, milestone, etc.). Or?Dressing stations for Division (...Brigade, etc.), will be established at... No. British Field Ambulance and No Indian Field Ambulance will provide the bearer-companies for these Dressing Stations." All men of the named division or brigades then know where to go. Other orders may be:?"No British Field Ambulance, less bearers of one section, anil No Indian Field Ambulance, will march with the centre column." 41 The bearers of one British Field Ambulance and section each of No. No. ...Indian Field Ambulance will march with the British Field Ambulance and advance guard. No No Indian Field Ambulance will remain with the ...
.
...
..
..
.
reserve
at
"
No orders to 0. O.'s of field ambulances are issued in divisional operation orders; such orders, and those to M. O.'s of battalions are contained in the detail orders of divisional P. M. O.'s In the issue of orders when places are mentioned the map in use will be referred to at the top of the order, " Reference map.'' Orders must be written e.g., legibly, clearly, and concisely ; they are to be dated a d tho exact time issued stated, and at the bottom is to be enumerated the different officers to whom copies have been sent (if to more than one). Orders should be signed, numbered, and re-read, to make sure that they are clear The orders issued to O. C.'s fiald ambulances should repeat the divisional orders as regards the details of troops and the position of all the field ambulances with their ambuhnce transport ; also orders regarding the opening of field ambulances and the establishment of collecting and dressing stations, with the method of evacuation to the rear of casualties, so far as the P. M. O division can give such orders at the time. In the writing of orders in a staff tour we are only given the same time as we would actually have on field service. "To form the habit of devoting many hours to the elaboration of long and detailed orders is prejudicial to the performance of good staff work in the field." All orders issued in connection with ti e medical arrangements require the approval of the G. O. C. of the force, division or brigade as the case may be. The requirements of the O. O. C. in other directions will sometimes conflict with what may appear to be the best way of handling the medical units in the various I'o avoid such incidents it situations that may arise. is well for the P. M. O. to consult the G. O. C. concerned or his staff on all matters of importance. For example, in connection with an extensive or important
Oct.,
191
THL VALUE OF STAFF TOURS.
l.j
engagement about to take place, it is recommended that the P. M O. of the force should have " plan of the medical arrangements prerared as concisely as possible in accordance with his own opinion as to tlie best method of keeping his resources in readiness. Such a representation of the medical plan of operations is of much value to the G. O. C. of the force and to the chief of the staff, both of whom are directly interested in knowiug that the best possible arrangements for the wounded are being made when a battle is imminent. The scheme will then form the basis of any final decision that is arrived at with regard to the medical tactical requirements, so far as they are consistent with military considerations.* Each medical officer present at the tour should keep a diary and enter in it everything that takes place concerning his special work, every order he has given, and every arrangement he would have made had the tour been a reality. He should also keep a complete file of the scheme, narratives, indoor and outdoor tasks set and carried out, reports submitted, plans, diagrams and maps prepared, so as to be able from the diary and file to submit a complete report of the start' tour at its conclusion, if called upon to do so. Junior medical officers on a staff tour should possess some knowledge of the work carried out by the P. M. O. of a force or division, and of the various other staffs of the field army? G. O. C'.s head quarters staff, A. G' s and Q. M G'.s staff, S. and T. staff, e'c. Such a knowledge would enable them to know to whom to refer when different questions crop up on field service and on large manoeuvres, thereby economising work, lessening correspondence and ensuring prompt attention to the matter in hand. Books required. The following books are indispensable : Training and Manoeuvre Regulations, 19('9, pp. 12 to 26. These give a full account of the objects, course, and method of conducting a staff tour and should be studied carefully before participating in one. Field Service Regulations, Part I, Organisation, 1909, Chap. II, pp. 18?34 ; all orders and reports are to be written in accordance with the instructions given in these pages. In Chap. I, p. 14, will be found a range table for rifle and gun-fire which is to be considered when selecting places for collecting and dressing stations, and in considering the movements of ambulance tongas. Field Service Regulations, Part II, Organisation and Administration, 1909, pp. 97?109, are most important ; they deal with practically all questions connected with the medical service in the field?general organisation, field ambulances, medical establishments, general system of dealing with casualties in action ; stationary, clearing, and general hospitals, ambulance trains, hospital ships, field medical store depots, etc. These subjects have to be carefully studied. Chapter IT, pp. 22?26, dealing with the general principles of war, organisation and functions of the forces in the field, Chap III, pp. 27?45, dealing with the general functions of the executive and of the component parts of the forces iu the field, and Chap. VI, pp. 57?71, on supplies, should be read. Field Service Manual, Medical, is very important from cover to cover and must be closely studied ; it has to be used as a vade mecum and need not therefore be further considered here. Field Service Regulations, India, Chap. IV, pp. 13?15, deal with various medical matters connected with field service. Other parte of this volume, such as those dealing with mobilisation, stores and equipment, supply and transport (clothing, rations, ambulance transport, etc.), should be read. War Establishments enables us to at once see the composition of any force and to ascertain its strength *
Strategical Service, p. 41.
and Tactical
Employment
of
the
Medical
375
with the normal proportions of the different arms, and the apportionment of the field ambulances at our disthe Staff College posal. Another useful book is
(Quetta)?
Provisional Memoranda, 1911, which, though unofficial, is almost indispensable to medical officers on staff tours, as it contains practically every table of equip-
ment and
personnel
he may want.
Field Service Pocket Book should be read carefully and the parts connected with the medical services in the field marked. Manual of Map Reading and Field Sketching is a very useful book to help us to understand the maps we have to study and to draw sketches of places and plane.
Army Book No. 153 (pocket note book) with carbon paper is used for writing memoranda, orders, etc., besides which we require a portfolio, sketching muteiiuls, paper clips, and pins with small coloured flags. Also a military compass and binocular field glass. The medical aspects of the subject of staff tours is by no means exhausted in the foregoing remarks ; what has been stated is specially intended to impress military medical officers, with the scope and objects in view, how much may be learnt from them, and the extent to which they broaden our views and quicken our intelligence in dealing with the requirements of large masses of men in the field. They teach us how to arrive at a correct decision with judgment promptly ; they point to the needs of the momant and show the fallacy of obscurity arising from too elaborate detail. They specially direct our thoughts and opinions so that with any change of military operations a corresponding change of medical tactics will be adopted forthwith. Staft tours an educational are most important from standpoint. To carry them out continuously and successfully necessitates medical officers being thoroughly familiar with all Regulations dealing with the medical service in the field They bring out the fact that medical tactics, and tactical employment of the or the strategical medical service in the field, is a comprehensive subject and one which should be mastered by us. Personally one feels that there should be a more definite means of instruction in the organisation and machinery employed by the medical department in the field than exists at present. A want of knowledge of the elements or general principles of military operations in the field is the only obstacle to the application of medical tactics. Staff tours test our knowledge and the facility we possess of applying that knowledge ; from them we learn our deficiencies and the way they may be remedied. They are specially useful to senior officers if the R A M. C. and I. M. S. who may hsve to act as S M O.'a of brigades, or P. M. O.'s of divisions or of a force just as regimental tours are specially useful to iunior medical officers who may be in medical charge of Staff tours corps units or sections of field ambulances. help to teach senior officers how to apply knowledge of administrative work in the field as distinguished from executive work, and how to maintain troops in i. state of health, fitness and efficiency. The medical aspects of staff tours have their interest for combatant officers likewise. Some military officers are quite conversant in a general way with the mechanism of our medical organisation during warfare, but the majority have only a very superficial knowledge of the medical work on field service, and it is desirable that senior medical officers taking part in staff tours should endeavour to impart all information they can and be ready to explain any part of our organisation when called upon to do so. Were all combatant officers acquainted with the medical tactics of war, they would frequently be in a position to give greater assistance to us in carrying out our duties than is now the case. On the other hand, during staff tours we have many facilities for acquiring some knowledge of the work of other of the departments army in the field. We are thrown into intimate relation with various officers in different branches of staff work, and almostengaged mechani-
376
THE INDIAN MEDICAL GAZETTE.
cally acquire functions
sorue
general knowledge
of their
specific
warfare. of staff tours
during
we get some idea of the By means difficulty of following fighting troops, a matter of much importance to administrative medical officers who must know the position of all fighting units to enable them
to make proper distributions of the field ambulances under their control. Hence the necessity in a large engagement of having a map of the area with numbered, named, or coloured flags attached to pins to mark the position of the troops on the map and of the medical units as e^ch da^'s fighting progresses. On the last day of the tour all the officers meet the director-in-chief, or director at the final conference during which the events of the tour are discussed and criticised. It should he remembered that all the medical arrangements of field service are known to staff officers, so that a general knowledge of our work in the field is not enough ; we must know our work thoroughly It is not to ba assumed that a staff tour is a pleasure trip ; it is usually very hard and close work, both in the camp and out. Throughout the tour we are being shown our deficiencies, or our weak points are being pointed out, or want of knowledge criticised, and our sound work eulogised ; yet throughout we are undergoing a f-rm of education that is most profitable to military medical officers. In the preparation of this paper I have been specially indebted to the different volumes of the Regulations connected with training and field service, to various articles on staff tours in the Journal of the Royal Army Medical Corps that have been published duiing the last few years, to Strategical and Tactical Employment of the Me.dical Service by Lt.-Col. Maximillian, Hitter von Hogn, translated by Lt-Col. W. G. Macpiierson, c m a., r.a M c , and to Study in Troop Leading and Management of the Sanitary Service in War, by Majors John F. Morrison and Edward L. Muneoh, U. S. A-
[Oct.,
1911.
Oct.,
STAFF TOURS AND THEIR USES.
1911.
(Oriqinnl
/
STAFF TOURS AND THEIR USES.
LIEUT.-COL.,
(Ed.),
I.M.S.
or Staff rides consist in workground without troops strategical and problems, and problems in staff duties?the com-
Definition.?Staff tours
ing
out on the
tactical
manders, staff and heads of administrative services represented by officers ; the troops and impedimenta
are are
The director in-chief prepares a scheme of the operations with general ami special ideas upon which the work of the staff four is based. Object.?The object of staff tours is to train higher who may be commanders, staff officers, and those * appointed to command or to the staff Instructions relative to the mode of locomotion, hour, date, and place of assembly, dress to be worn, arrangements regarding camp and messing, books and stationery required, postal arrangements, and other details are issued to those taking part in the staff tour some days before it begins. Other preliminary requirements are ths preparation of a scheme, appointment of a directing staff, and selection of officers to attend. Officers representing all branches of the military service are selected for staff tours, including?directorin-chief with two directors in largo staff tours, or director with two assistant directors in smaller 01109; general officers commanding the opposing forces, or one general officer commanding if only one force is represented, each with three or more general staff officers; A. A. G., A. Q. M. G., P. M. O. of the force, P. M. O.'s of divisions, S. M. O.'s of Brigades, 0. C.'s Geld ambulancesf and Sanitary Officer ; C. II E ; 0 C. mounted troops; O. C. artillery; Brigadiers, each with his
imaginary.
?
brigade major
; camp
commandant,
etc.
The director in-chief or director is appointed to conduct the instruction of officers attending the tour. For a double staff tour the director-in-chief adjudicates between the opposing forces. He controls the course of the staff tour by instructions issued to the directors of the two sides When the number of officers is large, the officers are subdivided into parties of 5 or 6 each under an officer of the directing staff. A camp commandant accompanies the tour or two He arranges about the when there are opposing sides encampment of the officers, messing, transport of
luggage,
etc.
The length of time occupied in staff tours for formations up to and including a division seldom exceeds four days, exclusive of the day of assembly and day of departure, and exclusive of the preparatory work with the appreciation, for smaller bodies of tro
? 110).
If the position fixed for the dressing stations of bearer-companies is at a distance from the firing line. collective) stations will be fixed as the action progresses, If the dressing station is close at hand, or reasonably near the fighting line, the establishment of collecting
stations is unnecessary ; the wounded are then taken direct to the dressing station from the fighting line. If the dressing stations are at a distance, then the woinded from the fighting line are brought (or find their way) to the collecting station and taken from there by the bearer-company men to the dressing station under the care of a medical subordinate. Medical officers with the authorised equipment remain with the dressing stations (both equipment and personnel bring reinforced when necessary). If there is no building or huts available, a tent is pitched. Ambulance tongas (if roads permit) otv animal transport and dandies* will rendezvous at dressii g stations to carry cases from them to the field ambulances. In selecting sites for dressing stations of bearercompanies divisional P. M. O.'s, and brigades. M.O.'s should remember that the infantry fire of the present day may be effective at a distance of 2,COO yards and makes an advance against it at anything closer than 1,000 yards inseparable from severe losses. They have likewise to consider that present-day artillery fire may be seriously effective at over 5,000 yards (even at 6,500 yaids), and at 4,000yards an advance in close formation against it is considered impracticable ; hence the wide extensions of infantry now adopted, which, amongst other advantages, gives more opportunity for men to take ewer.
Returning hospital trains are utilised to bring medical personnel and materiel towards the front. t The mobilisation and opening of general hospitals is most essential and should be the first in all field
P M. O of the force with regard to Sick and Wounded.?The P. M. O. of the force must be thoroughly familiar with the military situation, and especially with the conof the sick and ditions affecting the evacuation wounded. There are many conditions affecting this evacuation, such as the number of beds available in the field ambulances, extent to which further evacuation is possible, whether the line of evacuation is open, interrupted or blocked ; or whether an unlimited number may be evacuated. He must know along what
may nave to be
tongas.
station. *
steps medical organisation on a large scale; they should be brought into existence before the troops concentrate at the base. In them everything should be as perfect for the care and treatment of the sick and wounded as in any large hospital in India. I Hospital ships are usually arranged as accommodation, berths, etc., specially for sick andregards wounded, but any empty transport vessels returning from the seat of war
improvised
for the use of these patients.
Duties of the Evacuating the
*
Dandies and riding animals are alternative to ambulance The former are only used where wheeled traffic is
impracticable.
evacuation is to be adopted?by road, mil or if by road, length of the journey, whether suitable for ambulance tongas and supply wagons, and the arrangements for the journey; the transport to be used for the sick and wounded ordinary ambulance tongas, supply wagons, country carts, ponies, mule3, camels, dandies, and the exact number of eacli of these available. No evacuation is, of course, needed for the very slightly wounded or those very dangerously wounded. The periods of inactivity are to be employed in medical officers, medical subordinates, and routea
river;
training
field ambulances, erecting, striking, of field ambulance camps, preparing surgical tents for immediate use, arrangements for the reception of full number of wounded, inquiring into arrangements for those that will be left behind, and ascartaining the extent of local resources. Preparations for fighting that, is expected within a definite period include a knowledge of where all the reserve field ambulances are, at what distances in the rear they are, and making arrangements for lliem to reinforce the field army should this be necessary. Before an action field ambulances with the force are usually cleared of such sick and wounded f.s can be removed to the rear with safety, and all arrangements made for the riception of casualties from the field If a field ambulance, from the number of sick and wounded it contains, want of transport or other reasons, cannot be moved, its place in the division is to be taken temporarily by another field ambulance moved up from the reserve or the liueof communications. The ordinary routine throughout a campaign is that all sick and wounded, except trivial cases with the field army, are passed on towards the base as soon as practicable. Diese proceed with sick convoys, in charge of a medical officer or mtdical subordinate, with a N C. 0. and guard in charge of arms and ammunition, and are handed over at the next camp or billet on the line of communications, the transport, guard, and medical personnel returning to the field army. Further similarconvoys on the line of communications convey them to the base or rail head. The normal position of field ambulances in a camp is in r?ar of the centre of the force to which it belongs. If buildings are not used, field ambulances are pitched according to the plan laid down in Indian appendix to Combined Training. In a forward move when fighting is expected, the normal position of field ambulances is in rear of the ammunition column, but the G. O. C. of the force may consider it necessary to locate them immediately in rear of the fighting troops, or at a fixed distance behind the second line of transport In selecting sites for field ambulances b?fore an action, care is to be taken that the position is as neir the dressing station as the military conditions permit, and that there is a practicable road for ambulances from the front and a sufficient water-supply in the vicinity, If the position is not visible, direction flags are put up (F. S. M , M., ? 126). On the eve of an engagement efforts should be concentrated to prepare to receive the wounded and "Endeavours evacuate them as early as practicable. uiust always be made to evacuate the wounded for the
establishment
packing
and
following
of
loading
reasons :
1- In the event of an unfavourable issue the wounded must be saved from capture. 2. In the event of victory the area of operations should at least be cleared of the wounded who can be
evacuated, and the medical personnel devoted entirely to the care of those who are still left upon the field,
sometimes in great numbers and under very bad
con-
ditions.
majority of wounded who can be evacuated engagement are men who are fit for transport, seeing that the very seriously wounded are rarely capable of being sent back during the unfavourable condi3.
The
during an
tions of
a
battle, and,
373
IN ACTION.
Oct., 1911.]
as
the
wounded
come
in in
com-
at a time, the medical officers will not be tired out, and will be capable of treating them carefully and getting them fit for transport. 4. Wounded readily disregard the discomfort of transport in view of tlieir desire to get away from an area wliere they are exposed to the dangers and vicissitudes of battle."* As a general principle all the available medical resources of the field army that may be necessary should be pushed up to the battlefield after a victory, iu order to relieve as early as possible the suffering of the wounded who have not as yet been aided. In a planned battle the locality for keeping field ambulances in readiness should be behind the centra and (when practicable) at a spot where roadameet, from which fairly good communication can be maintained with all parts of the field, and which are easily found. Care is naturally taken to guard against selecting a place too far forward in the direction of the enemy, which, iu the event of a retreat, may btcome an impoitant position, and where no risk of blocking the passage of the troops should be run. The time for assembling the field ambulances at the selected spot is to be calculated so as to aV(,id too early a start. Our Regulations state that the will as far as may position of field ambulances (which be considered neceasaiy be pitched ready to receive the M- 0. of the force or wounded), will be fixed by the Pdivision under the orders of the G. O. C. ourselves the exact posiIt ia well for us to picture to field ambulances, dressing tion of the medical personnel, stations and the wounded during immediately after, a few hours after, and the morning following a successful
paratively small numbers
extensive engogement. , The more continued the fighting, the greater the necesthe of at the front. hospitala continred clearing sity for With an advancing army the field ambulances must also the force are encumbered advance and if those with in reserve and at the head (vith sick and wounded, those must take their of the line or lines of communications that the clearing hospital remember should We nhce in future campaigns), (which will probably be introduced head of the lines of and the field ambulances at the communication, are lines of communication hospitals M. Ob. lines of communi* under the orders of the P. O. of the force or of * division M. the P. but cation, where they can be best placed to assist .
may
.
suggest
0. of the force handles an action the P. M. are not attached the field ambulances as divisional ; they are acting independto brigades unless such brigades P M. O. works the Similarly a divisional ently the division ; they are field ambula. ces as part .of lhe P. M. O. of not under the orders of brigadiers, of lie force; the head-quarters with deals force the divisional staff. the with division a of O the P M medical arrangeWe have to bear in mind the varying is not anticipated for ments required when-fighting and expected at once. some time, is shortly expected the question of providing These contingencies afftct and the distribution accommodation for the wounded last-named case, for the In resources. medical of our all things have to be prepared and at hand
'"Soring
example, ready the
moment
fighting begins.
,
.
The different condiiioi'8 of defence, attack, defence of detacln d forces, counter-attacks, or the formation the disof temporary reserves?each of these affects as regards tribution of medical ambulances, especially of the the transport necessary for the evacuation wounded and in the selection of collecting and dressing stations.
t formulated battle
we have to conan attacking engagesider whether it is a defensive or distribution of the medical ment; in the former, the field ambulances is easy and definite and personnel
In
a
planned
or
* Strategical and Tactical Employment of the Medical Service pp. 30, 31. % Lt.-CoL. Maximillian Hiitkk von Hoex, translated by Lt. Col. W, G. Macpiierson, c.m.g.,
r.a.m.c.
THE INDIAN MEDICAL GAZETTE.
374
orders may be issued. In encounter battles no such definite arrangements can be made as regards time and place of distribution of medical personnel and equipment ; which have to depend on the time and place at which the opposing forces advance, and upon the plan of operations which the commanders of the opposing forces settle upon. Outdoor Work.?Medical officers as part of their outdoor work on a stiff tour may be asked to report on the facilities which exist in the neighbouring town or villages for establishing hospitals in them, what supplies there are, what additional medical assistance (if any) can be obtained ; to report on a given site for establishing a field ambulance under canvas, and if not suitable to select another and give reasons for the selection made ; report 011 the condition of the road or roads for wheeled ambulance transport ; select sites for dressing stations for a mixed infantry brigade in action at a particular place ; report on camping grounds and bivouacs for a brigade or a division, the water-supply in close proximity, etc , etc. The P. M. O. of a division may be required to go over a certain area of country to plan out the medical arrangements in the event of an action being fought there. These different outdoor tasks may have nothing to do with the main scheme of the staff tour. " Sketches, tables, diagrams and graphics should be furnisVed in connection with tasks when by so doing the work will gain in clearness and conciseness." It is always necessary to be fully acquainted with the local resources of the localities in and near the theatre of operations?buildings for hospitals, medical and surgic 1 equipment available, food for the sick,
transport,
etc.
In reporting on the resources of a town in India as to its capacity to receive the sick and wounded, etc , the following points deserve atiention. The three chief places to acquire knowledge of the town are?the municipal office, the butchery and the main thana or police station. In addition we should go over the whole town. Ascertain if there are any hospitals and dispensaries ; if so, where they are located, how many cases they can take in?these hospitals could not, of course, be empty at the time. The cases left in them by us would ba treated by the hospital staff, being controlled by us. Find out the existence or not of any other l uildings, institutions, churches, etc., that would be able to take in a certain number of cases, but would need some medical personnel, hospital establishment and equipment. We should examine any existing hotels, boarding houses and serais, that would have beds, bedding and ordinary utensils and some servants, but would require complete medical and nursing staff and equipment. Examine the town hall, markets, schools, etc , which might be able to shelter casualties, but have limited sanitary provisions.
We should also ascertain the number of medical men chemists' shops in the place, and how far these could be drawn upon ; the numbers of vehicles, horses, ponies that could be obtained as ambulance transport ; the amount of coolie labour that could be obtained to supplement the A. B. C. men. Find out also the number of furniture makers, makers of charpoys, iron-mongers, etc., with a viow to purchasing bedsteads and various metal cooking utensils from them in an emergency ; also the local resources for providing temporary latrine, kitchen, and similar accommodation should bo noted. The amount of food and comforts for the sick and wounded should be inquired into?milk, fowl, eggs, sheep, oxen, vegetables, etc.; this is, of course, the work of the S. and T. Corps, but it may fall to a medical oflicer to carry it ouf. The railway station, if there ia one, should be visited to see what facilities it otters for entraining patients, and also to see if a next station could ba established in and medical subordinates and
or near
it..
[Oct.,
1911.
Lastly, a plan of the place should be obtained, and ail the places mentioned marked on it, or if unable to get a plan, one should make a rough sketch of the town and places named. Writing Orders.?One of the most important and difficult parts of a staff tcur is that of writing orders. To do this correctly requires considerable practice and much thought. In this connection it is well to previously study F. S. R.t Part I, Operations, 1909, Chap. II, pp. 18-29, King's Regulations on the same subject, and F. S. M, J/./pp 26?28. The orders a P. M. O. of the force writes are draft orders for insertion in headquarters operation orders, and orders to P M. O.'s of divisions and independent brigades. The orders a P. M. O. of a division writes are draft orders for insertion in divisional opeiation orders and orders to O C.'s field ambulances, and, if necessary, to M. O.'s of corps uuits. The operation orders should only contain the infoimation on medical matters that everybody requires to know. For example, witli regard to an ensuing action, a draft order such as tlie following may be necessary :? ''No Indian Field British Field Ambulance, No Ambulance will receive casualties from Brigade Division," etc. " They will occupy the following position : No No British Field Ambulance at " Indian Field Ambulance at (naming ? village, copse, bridge, milestone, etc.). Or?Dressing stations for Division (...Brigade, etc.), will be established at... No. British Field Ambulance and No Indian Field Ambulance will provide the bearer-companies for these Dressing Stations." All men of the named division or brigades then know where to go. Other orders may be:?"No British Field Ambulance, less bearers of one section, anil No Indian Field Ambulance, will march with the centre column." 41 The bearers of one British Field Ambulance and section each of No. No. ...Indian Field Ambulance will march with the British Field Ambulance and advance guard. No No Indian Field Ambulance will remain with the ...
.
...
..
..
.
reserve
at
"
No orders to 0. O.'s of field ambulances are issued in divisional operation orders; such orders, and those to M. O.'s of battalions are contained in the detail orders of divisional P. M. O.'s In the issue of orders when places are mentioned the map in use will be referred to at the top of the order, " Reference map.'' Orders must be written e.g., legibly, clearly, and concisely ; they are to be dated a d tho exact time issued stated, and at the bottom is to be enumerated the different officers to whom copies have been sent (if to more than one). Orders should be signed, numbered, and re-read, to make sure that they are clear The orders issued to O. C.'s fiald ambulances should repeat the divisional orders as regards the details of troops and the position of all the field ambulances with their ambuhnce transport ; also orders regarding the opening of field ambulances and the establishment of collecting and dressing stations, with the method of evacuation to the rear of casualties, so far as the P. M. O division can give such orders at the time. In the writing of orders in a staff tour we are only given the same time as we would actually have on field service. "To form the habit of devoting many hours to the elaboration of long and detailed orders is prejudicial to the performance of good staff work in the field." All orders issued in connection with ti e medical arrangements require the approval of the G. O. C. of the force, division or brigade as the case may be. The requirements of the O. O. C. in other directions will sometimes conflict with what may appear to be the best way of handling the medical units in the various I'o avoid such incidents it situations that may arise. is well for the P. M. O. to consult the G. O. C. concerned or his staff on all matters of importance. For example, in connection with an extensive or important
Oct.,
191
THL VALUE OF STAFF TOURS.
l.j
engagement about to take place, it is recommended that the P. M O. of the force should have " plan of the medical arrangements prerared as concisely as possible in accordance with his own opinion as to tlie best method of keeping his resources in readiness. Such a representation of the medical plan of operations is of much value to the G. O. C. of the force and to the chief of the staff, both of whom are directly interested in knowiug that the best possible arrangements for the wounded are being made when a battle is imminent. The scheme will then form the basis of any final decision that is arrived at with regard to the medical tactical requirements, so far as they are consistent with military considerations.* Each medical officer present at the tour should keep a diary and enter in it everything that takes place concerning his special work, every order he has given, and every arrangement he would have made had the tour been a reality. He should also keep a complete file of the scheme, narratives, indoor and outdoor tasks set and carried out, reports submitted, plans, diagrams and maps prepared, so as to be able from the diary and file to submit a complete report of the start' tour at its conclusion, if called upon to do so. Junior medical officers on a staff tour should possess some knowledge of the work carried out by the P. M. O. of a force or division, and of the various other staffs of the field army? G. O. C'.s head quarters staff, A. G' s and Q. M G'.s staff, S. and T. staff, e'c. Such a knowledge would enable them to know to whom to refer when different questions crop up on field service and on large manoeuvres, thereby economising work, lessening correspondence and ensuring prompt attention to the matter in hand. Books required. The following books are indispensable : Training and Manoeuvre Regulations, 19('9, pp. 12 to 26. These give a full account of the objects, course, and method of conducting a staff tour and should be studied carefully before participating in one. Field Service Regulations, Part I, Organisation, 1909, Chap. II, pp. 18?34 ; all orders and reports are to be written in accordance with the instructions given in these pages. In Chap. I, p. 14, will be found a range table for rifle and gun-fire which is to be considered when selecting places for collecting and dressing stations, and in considering the movements of ambulance tongas. Field Service Regulations, Part II, Organisation and Administration, 1909, pp. 97?109, are most important ; they deal with practically all questions connected with the medical service in the field?general organisation, field ambulances, medical establishments, general system of dealing with casualties in action ; stationary, clearing, and general hospitals, ambulance trains, hospital ships, field medical store depots, etc. These subjects have to be carefully studied. Chapter IT, pp. 22?26, dealing with the general principles of war, organisation and functions of the forces in the field, Chap III, pp. 27?45, dealing with the general functions of the executive and of the component parts of the forces iu the field, and Chap. VI, pp. 57?71, on supplies, should be read. Field Service Manual, Medical, is very important from cover to cover and must be closely studied ; it has to be used as a vade mecum and need not therefore be further considered here. Field Service Regulations, India, Chap. IV, pp. 13?15, deal with various medical matters connected with field service. Other parte of this volume, such as those dealing with mobilisation, stores and equipment, supply and transport (clothing, rations, ambulance transport, etc.), should be read. War Establishments enables us to at once see the composition of any force and to ascertain its strength *
Strategical Service, p. 41.
and Tactical
Employment
of
the
Medical
375
with the normal proportions of the different arms, and the apportionment of the field ambulances at our disthe Staff College posal. Another useful book is
(Quetta)?
Provisional Memoranda, 1911, which, though unofficial, is almost indispensable to medical officers on staff tours, as it contains practically every table of equip-
ment and
personnel
he may want.
Field Service Pocket Book should be read carefully and the parts connected with the medical services in the field marked. Manual of Map Reading and Field Sketching is a very useful book to help us to understand the maps we have to study and to draw sketches of places and plane.
Army Book No. 153 (pocket note book) with carbon paper is used for writing memoranda, orders, etc., besides which we require a portfolio, sketching muteiiuls, paper clips, and pins with small coloured flags. Also a military compass and binocular field glass. The medical aspects of the subject of staff tours is by no means exhausted in the foregoing remarks ; what has been stated is specially intended to impress military medical officers, with the scope and objects in view, how much may be learnt from them, and the extent to which they broaden our views and quicken our intelligence in dealing with the requirements of large masses of men in the field. They teach us how to arrive at a correct decision with judgment promptly ; they point to the needs of the momant and show the fallacy of obscurity arising from too elaborate detail. They specially direct our thoughts and opinions so that with any change of military operations a corresponding change of medical tactics will be adopted forthwith. Staft tours an educational are most important from standpoint. To carry them out continuously and successfully necessitates medical officers being thoroughly familiar with all Regulations dealing with the medical service in the field They bring out the fact that medical tactics, and tactical employment of the or the strategical medical service in the field, is a comprehensive subject and one which should be mastered by us. Personally one feels that there should be a more definite means of instruction in the organisation and machinery employed by the medical department in the field than exists at present. A want of knowledge of the elements or general principles of military operations in the field is the only obstacle to the application of medical tactics. Staff tours test our knowledge and the facility we possess of applying that knowledge ; from them we learn our deficiencies and the way they may be remedied. They are specially useful to senior officers if the R A M. C. and I. M. S. who may hsve to act as S M O.'a of brigades, or P. M. O.'s of divisions or of a force just as regimental tours are specially useful to iunior medical officers who may be in medical charge of Staff tours corps units or sections of field ambulances. help to teach senior officers how to apply knowledge of administrative work in the field as distinguished from executive work, and how to maintain troops in i. state of health, fitness and efficiency. The medical aspects of staff tours have their interest for combatant officers likewise. Some military officers are quite conversant in a general way with the mechanism of our medical organisation during warfare, but the majority have only a very superficial knowledge of the medical work on field service, and it is desirable that senior medical officers taking part in staff tours should endeavour to impart all information they can and be ready to explain any part of our organisation when called upon to do so. Were all combatant officers acquainted with the medical tactics of war, they would frequently be in a position to give greater assistance to us in carrying out our duties than is now the case. On the other hand, during staff tours we have many facilities for acquiring some knowledge of the work of other of the departments army in the field. We are thrown into intimate relation with various officers in different branches of staff work, and almostengaged mechani-
376
THE INDIAN MEDICAL GAZETTE.
cally acquire functions
sorue
general knowledge
of their
specific
warfare. of staff tours
during
we get some idea of the By means difficulty of following fighting troops, a matter of much importance to administrative medical officers who must know the position of all fighting units to enable them
to make proper distributions of the field ambulances under their control. Hence the necessity in a large engagement of having a map of the area with numbered, named, or coloured flags attached to pins to mark the position of the troops on the map and of the medical units as e^ch da^'s fighting progresses. On the last day of the tour all the officers meet the director-in-chief, or director at the final conference during which the events of the tour are discussed and criticised. It should he remembered that all the medical arrangements of field service are known to staff officers, so that a general knowledge of our work in the field is not enough ; we must know our work thoroughly It is not to ba assumed that a staff tour is a pleasure trip ; it is usually very hard and close work, both in the camp and out. Throughout the tour we are being shown our deficiencies, or our weak points are being pointed out, or want of knowledge criticised, and our sound work eulogised ; yet throughout we are undergoing a f-rm of education that is most profitable to military medical officers. In the preparation of this paper I have been specially indebted to the different volumes of the Regulations connected with training and field service, to various articles on staff tours in the Journal of the Royal Army Medical Corps that have been published duiing the last few years, to Strategical and Tactical Employment of the Me.dical Service by Lt.-Col. Maximillian, Hitter von Hogn, translated by Lt-Col. W. G. Macpiierson, c m a., r.a M c , and to Study in Troop Leading and Management of the Sanitary Service in War, by Majors John F. Morrison and Edward L. Muneoh, U. S. A-
[Oct.,
1911.
