'Mesopotamia Commission. Report of the Commission Appointed by Act of Parliament to Enquire into the Operations of War in Mesopotamia, together with a Special Report by Commander J Wedgwood, DSO, MP, and Appendices. London: HMSO, 1917.' [‎46v] (92/248)

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PART X.—MEDICAL BREAKDOWN.
* See Part X., para. 78.
t See Part X., para. 82.
F. Supplementary.
In view of the unsuitability of the Mesopotamian climate for tue purposes of convalescence,
the policy of shipping to India as many sick as possible was wisely pursued, though it, of
course, increased the statistical total of men invalided to India. During the worst
months of the hot season of 1916 a very large number of officers and men were thus invalided
to India, though—we are glad to say—this high invaliding rate rapidly decreased
as the weather became cooler. But in the battle against disease it is the preparatory
work which tells, and if Surgeon-General Hathaway profited by the preparations of Colonel
Hehir in the spring of 1915, so Surgeon-General Treheme was bound to suffer from any lack
of preparations by Surgeon-General Hathaway in the spring of 1916.
Statistical Evidence of Colonel James.
107. In this connection we would refer to the able evidence tendered to us almost
at the end of our enquiry by Lieut.-Colonel James, who was appointed Chief Staff Officer
for Sanitation in Mesopotamia early in 1916. Colonel James produced an interesting
series of statistics of admissions to hospitals for sickness in Mesopotamia in the year
1915-1916, and he compared these with similar statistics for previous campaigns in a manner
which shows up in a most favourable light the result of the medical authorities’ work in
Mesopotamia. But we do not agree with Colonel James that he has adopted a fair
criterion. The latest of Colonel James’ compared campaigns was in 1904, the earliest
in 1847. No science has leapt forward more boldly and rapidly in recent years than preven
tive medicine. Many of the prophylactic and sanitary measures against disease which
are now a commonplace were unknown in these earlier campaigns, and they are not, there
fore, a fair basis for comparison. In one sense, indeed, the heavier sick-rates of earlier
campaigns might even be held to aggravate the indictment. We have shown that the
Indian authorities did not provide sufficient hospitals, personnel and equipment for the
actual number of patients. But if, as Colonel James would seem to infer, they ought to
have expected a vastly larger number of patients, the omission to provide even for the
lesser number is all the more reprehensible.
108. We do not, however, ourselves consider that the Indian Medical Authorities should v
have provided for, or be judged hy, the sick-rates of ten or twenty years ago. The real
test is whether the measures taken are considered satisfactory tested by contemporary
standards. Colonel James’ calculated rate of admissions to hospital for sickness in a year
in 1915-16 is 1,550 per 1,000 of the average strength of the force. If we understand
Colonel James correctly, this means that, supposing no reinforcements had been sent, in one
year every man in the force would have been incapacitated by illness once, and more than
half of the men in the force would have been incapacitated by illness twice. In other
words, the preventive measures adopted would not have succeeded in protecting from
disease a single man in the force. We cannot believe that this is a standard, which can be
considered satisfactoiy, or that it could not have been improved upon by the adoption of
earlier and more energetic measures. In this our opinion is amply confirmed by the
Report of the War Office Sanitary Commission and the other documents referred to
in para. 104 above. We might add that the backwardness and obstruction of the
authorities in Mesopotamia in regard to medical and sanitary reforms is the main subject
of Colonel James’ own evidence before the Vincent-Bingley Commission.
Neglect to apply to England for Assistance.
109. We have already referred to* a despatch of March, 1914, from the Viceroy to the
Secretary of State which shows that shortly before the outbreak of war the deficiency in
medical officers in India on mobilisation was placed at 360 and of military assistant surgeons
at 246. The figures quoted to us elsewhere do not always agree with these, but it is quite
evident, and, indeed, admitted, that the full military force in India could not be mobilised for
war without considerable medical assistance from home. The effect of this was seen in the
deficiencies in hospitals, personnel and equipment which existed from the first in Mesopo
tamia and culminated in the disaster after Ctesiphon and Sheikh Saad. It appears to us,
therefore, extraordinary that not only was assistance in medical personnel and equipment
not asked for from England on a large scale during the first year of the operations in Mesopo
tamia, but that, as we show elsewhere,! in August, 1915, such assistance was actually refused
by the Indian Government. The Viceroy informed us that no shortage was reported to
him. But the deficiencies on mobilisation had been known to the Indian Government for
years. The Commander-in-Chief and the D.M.S. appear to have been actuated by the T
belief that nothing could be spared from England. Some ground for this belief is afforded