THE WORKING OF VOLUNTARY AID DETACHMENTS 1.

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B. BALGARNIE, M.B.LoND., F.R.C.S.ENG.
Assistant County Director, Hants Subdivision, B.R.C.S

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I SHALL discuss Voluntary Aid Detachments under the following headings, viz.:

(1) Their birth;

(2) Their boyhood;

(3) In foreign countries;

(4) At the present day.

(1) THE BIRTH OF VOLUNTARY AID DETACHMENTS.

When M. Dunant, horrified with the horrors of that bloody campaign in 1859, succeeded in calling together a Conference at Geneva, in 1863, his action created a sensation throughout the civilized world. M. Dunant himself frankly admitted that what caused him to turn his attention to this subject was the heroic conduct of our national heroine, Florence Nightingale, who thus, in a sense, was the unconscious instigator of this world-wide movement, the formation of Red Cross Societies.

M. Dunant made two great postulates :-

 

(i) International recognition of the neutrality of all hospitals, and of the personnel and supplies of ambulances for the use of the sick and wounded of belligerents.

(ii) The' organization of voluntary medical relief societies for the aid of the public medical services under the stress of war.

The first was not original, but the second was M. Dunant's own offspring; and throughout his life it was to voluntary aid that he especially devoted his energies. Nations, especially at peace, have short memories, and when the Geneva Convention of 1864, preceded by the preliminary Conference of 1863, became an accomplished fact, it was hailed as a new heaven and a new earth.

History does nothing if it does not repeat itself, and if the histories of wars between 1581 and 1864 be investigated, one finds that there had been a steady attempt made between the combatants
engaged, to alleviate the miseries of the battlefields; and during that, period no fewer than 291 treaties had been drawn up for this laudable purpose. The best known was one drawn up in
1800 by Napoleon's chief medical officer, Baron Percy, and its five articles may be regarded as the framework of the Geneva Convention of 1864.

1. An address delivered to the Aldershot Command, Military Medical Society.

The Convention of 1864 did not embody Dunant's original views, which, as we have seen, were to have independent groups of voluntary workers organized for succouring wounded on the battlefield; in other words, the formation of Red Cross Societies.

At the opening meeting, in 1864, it was made clear to the delegates that the object of the Convention was to draw up an agreement by which the regular organized medical services of armies would be enabled to carry on their work under the most favourable conditions; and that certain Powers had only consented to take part in the negotiations on the understanding that the Conference would have nothing to do with the resolutions of the 1863 Conference, at which Dunant's views on voluntary aid were given special prominence.

There is no doubt that the sentiments of Dunant, as determined in the Conference resolutions of 1863, took a great hold on the public mind, with the result that the Geneva Convention of 1864 was brought more or less into discredit. Many proposals were made to revise it; an attempt was made in 1868, chiefly due to the experiences of the war between Prussia and Austria in 1866, and certain new articles were added to the original Convention, but these were never ratified by the Powers, owing chiefly to the Franco-Prussian War having broken out.

The new Convention of 1906, in its Articles 10 to 16, expressly recognizes Red Cross Societies; thus it will be seen that forty-two years elapsed ere the views advocated by the founder fructified and though the old Convention has done much to assist the military side of medical work on the battlefield, voluntary aid has existed more or less on sufferance.

Soon after the Geneva Convention was signed Red Cross Societies sprang into existence in every nation of Europe. France and Prussia were amongst the first in the field in 1864, Russia followed in 1867. while Great Britain was about last, as it did not form the first of its Aid Societies until 1870.

(2) THE BOYHOOD OF VOLUNTARY AID DETACHMENTS.

 

It is unfortunately a truism, that our good old country is generally backward in adopting new ideas. So it has been with voluntary aid, for, as I have just now mentioned, we were the last in the field, and are still, I regret to say, a long way in the rear. Nevertheless, our Voluntary Aid Societies have done excellent service in many of the campaigns that have been fought during the last forty years.

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Our slackness, when compared with other nations, is not to be wondered at, for, though we are a philanthropic nation, we are not a military one; and, unless our record of freedom from invasion for upwards of nine hundred years be rudely broken, is there any possibility of our ever becoming one?

"The National Society for Aid to the Sick and -Wounded in War" was the first Red Cross Society to be established in England, and I should like to quote a passage from a speech of Lord Rothschild,
when speaking of its foundation ;- 

"When the Franco-German War broke out in 1870, that gallant soldier, the late Lord Wantage who had planted the colours of his regiment on the heights of Alma, for which he received the Victoria Cross, and who had served with distinction all through the campaign in the Crimea, who knew from experience the misery and suffering of wounded and sick soldiers in a campaign, and who was aware of how little was done in those days to alleviate men fighting for the honour and glory of their Sovereign and country-took advantage of the new Geneva Convention to start the Society over which he long presided, viz., the "National Society for Aid to the Sick and Wounded in War."

Thus, as Dunant is regarded as the prime founder of the Red Cross movement, so Lord Wantage may be regarded as its founder in the British Empire.

The National Aid Society has done much. From 1870 to 1905 it expended half a million of money in assisting the sick and wounded in war. In the Franco-German War it provided £250,000, and employed nearly 200 agents, surgeons, and nurses. It accomplished similar good services in the Turco-Servian and Russo-Turkish Wars.

In our own campaigns it rendered assistance in the Zulu War of 1879, the Egyptian Campaign of 1884, the Boer War of 1881, and la;st, but not least, in the late South African War, 1899 to 1902. In this last campaign it expended £162,000. Twenty-one commissioners and agents were employed; the hospital ship "Princess of Wales" was chartered, and the hospital train "Princess Christian" purchased. The work in this war was carried out in connexion with and under the direction of the Central Red Cross Committee.

This Committee was established in 1899 with the object of bringing the National Aid Society, the St. John Ambulance Society, and the Army Nursing Service Reserve more in touch with the Army Medical Service in time of war, and the Foreign Office notified all Foreign Chancelleries that this body was the only one authorized to deal with Red Cross matters throughout the Empire. This is the first· occasion that the term Red Cross, as applied to a voluntary organization, was used. Its name was changed in 1904 into the " Central British Red Cross Council."

The Society as it at present exists was inaugurated at a meeting held at Buckingham Palace, on July 17, 1905, under the presidency of Her Majesty Queen Alexandra, and I cannot better explain the
objects of the Society than by quoting Her Majesty's brief speech:- 

"It has been on my mind ever since the South African War, when I became President, to try to reorganize the Red Cross Society on a more practical and sound basis. It affords me, therefore, the greatest satisfaction to learn that the Red Cross Council has consented to join hands with the National Aid Society, founded by that distinguished soldier, the late Lord Vantage, under one
title, the British Red Cross Society.

I therefore propose that the new organization should be based upon membership and association, and the members and associates of the Society should be recruited from all classes throughout the
Empire.

"The Society shall be entirely voluntary, and while in touch with the War Office and Admiralty the Society shall be organized and act wholly independently of those departments in times of peace, but naturally in time of war it must be under naval and military control.

"I therefore appeal to all women of the Empire to assist me all carrying out this great scheme, which is essentially a woman's work, and which is the one and only way in which we can assist our brave and gallant Army and Navy to perform their arduous duties in time of war."

To simplify the objects of the Society a little more, I would briefly summarize them as follows :-

(1) To furnish aid to the sick and wounded in time of war, such aid necessarily being supplementary to that furnished by the medical departments of the Navy and Army.

To repeat Dunant's oft expressed sentiments: "It is impossible that the medical provisions of the Navy ·and Army, in the matter especially of personnel, can be maintained in time of peace at the standard demanded by the stress of war."

(2) To prevent. the Medical Services being worried by offers of help, in personnel or kind, in time of war, all such offers of help must come through the Red Cross Society. I cannot help thinking that this provision must appeal to the Army Medical Service strongly, for one can well imagine the confusion that might reign at the War Office, if that building were besieged by would-be nurses and bearers, anxious to help, to say nothing of the hosts of gifts for the troops, from night caps to chocolates. The Red Cross Society in time of peace will have ascertained and tabulated the extent and nature of the voluntary aid which can be depended upon or expected in the event of war. 

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(3) It is not proposed that any stores or materials to any extent, at all events, shall be collected in time of peace, but each unit throughout the country will know where to put its hand on such stores at a moment's notice. For example, to give from my own experience in my own district: I have no hesitation in saying there is hardly a village of any size in the whole of the Hartley Wintney subdivision of Hampshire that could not equip a hospital, say, of twenty beds, at twenty-four hours' notice. I do not pretend to say a hospital with all modern improvements, but a hospital with decent beds and the ordinary furniture and utensils that patients would require. I venture to suggest that were a big engagement to be fought in the neighbourhood of Aldershot I presume a not impossible contingency in case of invasion-all these hospitals would in all likelihood be filled to overflowing.

How the Society Pays its Way.

 

When the British Red Cross Society was formed in 1905 the National Aid Society was ,incorporated
with it; the latter body possessed a certain capital sum which had been subscribed on previous occasions. The interest from this sum is sufficient for the -expenses of the headquarters' organization, but, of course, all branches throughout the Empire are supported by their own voluntary efforts. This capital sum can only be touched in case the Empire is involved in a war; in cases where foreign nations are at war, such as the recent war in the Balkans, all the help that was sent to the combatants was raised independently of the present Red Cross funds.

The branches are maintained by subscriptions of members and associates: the members subscribe one guinea per annum, or promise five guineas in case of a war in which British troops are employed; the associates subscribe five shillings per annum, or guarantee one guinea in like circumstances.

Organization of the Red Cross Society.

 

The Society is primarily governed by a Council, which was elected by their Majesties; and as vacancies occur these can be filled up by the Council itself. 

Secondly, there are formed. branches throughout the Kingdom or rather Empire. In the United Kingdom these branches follow the counties and the county boroughs, and are identical with the County Association areas. The County Association, as you know, is concerned with the Auxiliary Forces of the realm; all Voluntary Aid Detachments, coming under this category, are nominally under the direction of the County Associations. Each County has its President, its Committee, its County Director, and Honorary Secretary.

The county is again subdivided into areas corresponding with the Poor Law areas, a very useful subdivision. These subdivisions are controlled by a Vice-President, a Committee, an Honorary Secretary, and an Assistant Country Director. 

 

The Committee of a branch may either remain a latent Committee or may concern itself actively with Red Cross work. A latent Committee does nothing in time of peace beyond getting promises. of subscriptions, but in time of war it may at once proceed to organize, and deal with offers of voluntary aid. I fear, however, a latent Committee would still be latent when war arose, for there is no axiom more proved than this, unless you prepare for war during peace there will be no time to prepare
when war comes. So I think we may dismiss a latent Committee without further remark.
Active Committees.-I shall refer to the work of Active Committees presently.

(3) VOLUNTARY AID IN FOREIGN COUNTRIES.

 

I have examined the handbooks of the medical services of foreign armies, and I am going to give you the impression the perusal of those textbooks has left on me.

1. The First Impression is their complete Organization and Preparedness for War.

Every state has Its Voluntary Aid Detachments ready for war.

Germany - I cannot do better than quote the organization that Germany has. At the head of all is an Imperial Commissioner and Military Inspector of Voluntary Aid. This appointment, which is made by the Emperor, is held during peace as well as war. The inspector has under him two assistant commissioners. All Government officials must give him whatever information he may require to enable him to carry on his duties: In addition, one combatant and one medical officer from the head office are in constant touch with him and are appointed with a view to facilitate communications
between him and the War Office. He has also the assistance of standing Committees of the German Red Cross Societies. The Imperial Commissioner is obliged to forward to the War Office annually a report on the state of the detachments, and the War Office on their part inform him what  preparations should be made in the event of mobilization. He appoints delegates from V.A.D.'s to assist in the mobilization. When war breaks out, the Imperial Commissioner hands over his office to one of his assistant commissioners and joins the headquarters' staff of the Commander-in-chief in the field, where he directs voluntary aid in association with the Inspector-General of the Lines of Communication and Railways and the D.M.S. of the Field Force.

This organization, with its German thoroughness, though a type of the rest, struck me as the most workmanlike of the lot.

2. Preparation in Materiel.

 

As a humble local representative of the British Red Cross Society, I must confess I am overwhelmed when I read what is done abroad. Here one can command perhaps a handful of army stretchers of are obsolete pattern, a few home-made ones, made by the help of an estate carpenter, and the promise of some beds and furniture should an invasion occur. What is this compared with what Italy
can show. 

Italy. 64 small ambulances for mountain warfare, 8 war hospitals of 100 beds, 8 war hospitals of 50 beds, 36 war hospitals of 50 beds for pack transport, 14 hospital trains of 200 beds, 1 hospital train in Sicily of 100 beds, 2 sets of equipment for hospital ships for the Navy, 1 set of equipment for a river ambulance, and 65 rest stations. 

Italy's example suffices; but all the other countries are equipped, more or less, on similar lines.

3. Lifembership of Voluntary Aid Societies.

The figures of the various countries are so erratic that there does not seem much to be gleaned on this head. Russia, e.g., has a membership of 1,000,000; France only 50,000; England, with the St. John Ambulance Association, some 100,000; and Italy's figures are only about 6,000.

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4. Finance.

Here again the figures vary enormously. Russia heads the list with a million; Germany, Austria, and France about half a million; and England's capital sum, though not officially given, is understood
to be about £70,000. 
5. Training.

France.- France seems to be 'facile princeps' in her endeavour to organize the training of her voluntary aid personnel. The premier society, viz., "La Societe Francaise de Secours aux Blesses
Militaires," has taken very active steps in establishing dispensary schools all over the country. There are three in Paris and about thirty-five in the provinces. Ladies attend these dispensaries, and
may afterwards attend the civil hospitals in Paris. The course of instruction lasts five months, and a diploma is granted after a final examination. These dispensaries have, I believe, been the cause of much ill feeling on the part of the medical profession in France. They probably rob the profession of many patients, and as they are largely for instructional purposes, one can imagine that many cases
are treated which ought to be under the care of the local practitioners. There are two other societies in France, which are also doing valuable work.

I shall not attempt to give any further details and the three examples I have given show that these countries are alive to the importance of fostering the Red Cross movement to their utmost capacity.
I fear this country, however, being the last to start, is still the last in the field, and until the country can be brought to realize the necessity for voluntary aid she is likely to remain there.

(4) VOLUNTARY AID AT THE PRESENT DAY.

 

We have seen that the British Red Cross Society came into being in 1905, but it was not until 1909 that Voluntary Aid Detachments began to be organized. Since this date the movement has made great strides.

Up to June, 1912, I find that in England, Scotland, and Wales there is a total of,475 detachments, with a total membership of just 44,000. I also note that there are considerably more than four
times as many women's detachments as there are men's, and as regards individuals there are rather more than two women to one man.

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Our County of Rants is regarded as the premier county; as regards personnel, without the Isle of Wight, the figures are just below Sussex, but with the Island they are considerably above, the numbers being 2,600.

Formation.-We must first inquire how Voluntary Aid Detachments are formed. I cannot do better than refer to Form D, which is issued by the British Red Cross Society. It is headed" Medical Organization in Case of Invasion."

Under the scheme the British Red Cross Society is the body recommended by the War Office to the County Associations for the carrying out of this important work .

Objects in View.-The pamphlet then gives the objects in view. It begins by stating that the medical organization of the Territorial Force, though complete in many details, is lacking in certain units, which are as follows:

(1) Clearing hospitals;

 

(2) stationary hospitals;

 

(3) ambulance trains;

 

(4) other formations.

You will notice, there are two administrative authorities, viz., the County Associations and the British Red Cross Society, with the result that there are many complaints that we do not know who
are our masters; in fact, we are rather like lost sheep on the mountain side.

Keeping up Interest Raving got our detachments formed, our great difficulty is to keep our personnel interested, and to prevent them forgetting what they have already learnt: and there indeed is the rub.
When you have put up imaginary fractured clavicles with triangular bandages about fifty times and squeezed a small boy's ribs, in an attempt to resuscitate an imaginary drowned person until his sides ache, our members begin to find the process a bit wearisome, and I cannot blame them. The only way to make Voluntary Aid Detachments really efficient is to find some means for keeping up their interest, and so I shall be very grateful for any suggestions that any members of your Society can give. 

To keep up Interest.-

 

(l) Lectures during the winter on invalid cooking, hygiene, &c.

 

(2) Local Competitions.-Our late Vice-President, Lady Calthorpe, very kindly presented two very handsome silver bowls, to be competed for annually by detachments from the different parishes
in the area. This evokes keen interest and great preparation for the event.

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(3) Divisional Competitions.- Basingstoke Division challenged the Rartley Wintney Division quite recently, the subjects being triangular and roller bandaging, sick cooking, bed making, &c.;
teams practise for weeks beforehand, and they become very efficient in these details.

(4) By Small Field Days.-Before last summer, when we had a scheme given us, we used to devise our own little manouvres-e.g. in September, 1911, making Winch field Station an entraining
station, we brought in at night time about sixty or seventy wounded, which were collected at five or six different points agreed upon, in improvised farm carts, the distances being generally three or four
miles from the station. The casualties were first placed in a rest hospital and then entrained.

(5) By Combined Manouvres.-Certainly the most instructive piece of work that we have done was in July last, and this was on receipt of orders from the County. headquarters.

The Scheme was this: A battle was fought in the vicinity of Aldershot and Fleet. This was made quite realistic by General Lomax kindly arranging a divisional exercise on the day. The casualties were brought in by four ambulance wagons to the number of 150. The previous night we had fitted up sixteen cattle trucks with strong chestnut poles and rope slings, two being fitted up with Colonel James's modification of Zavodovski's method. Five clearing hospitals had been established in buildings or tents, where the wounded were temporarily placed preparatory to being entrained.
Two really excellent stationary hospitals (which for the purposes of the scheme were called base hospitals) were established at Basingstoke. Although the casualties were not received until 3 p.m., the train left at the scheduled time, 5.30, with 100 sling cases and fifty sitting up cases in three railway coaches. Each stretcher was lashed to prevent swaying either laterally or fore and aft, and I am pleased to say not a single lashing gave way, though I admit I was nervous.

At Basingtoke improvised ambulance carts conveyed the wounded to the hospitals, which were situated about half a mile from the station. I might add also that we cooked, in an extemporized field
kitchen, a good hot dinner for four attendants and the casualties, 150 in number, which was much appreciated. 

Now you cannot carry out a scheme like this for nothing, and it cost us at the Fleet end about £50. The War Office did not help, nor the Red Cross Society, nor the County Association; the money had to come out of our own pockets. I mention this in no niggardly spirit, but just to state that many districts which do not possess wealthy friends could not undertake it.

Our expenses would have been much more but for assistance in kind; and I would like to specially thank your Corps, who kindly lent us some 100 army stretchers which were invaluable, for the expense of hiring these or making them would have been prohibitive.

CONCLUSIONS.

 

(1) That Dunant's views, which were enumerated in my text, still hold good, viz., that voluntary aid is essential in time of War.

(2) That all civilized countries have recognized this fact 

 

(3) That we are the last to start, and are many many years behind our foreign friends.

(4) That we have a large, and I venture to think quite large enough, body of men and women, keen on their work and eager for improvement.

(5) That such enthusiasm should be freely encouraged by the authorities.

(6) 'l'hat at present the V.A.D.'s are wasted organizations.

(7) That in time of war mobilization would be next to impossible.

(8) That there should be some high War Office official, equivalent to the German Imperial Commissioner, who with a staff should devote the whole of his time to the matter of voluntary aid.

 

(9) That the War Office might help enormously by allocating instructors to small groups, say two or three County Divisions.

(10) That they might also help by giving or lending such material as they could easily spare .

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