As a surgeon it has been my good fortune to have charge of a hospital whose position was almost ideal.  Always close to the front, we received our cases at the earliest possible moment, and could deal with them practically first hand.  Every day I realized more strongly the advantages of such a hospital, and the importance for the wounded of the first surgical treatment they receive.  Upon this may well depend the whole future course of the case.  No wounded man should be sent on a long railway journey to the base until he has passed through the hands of a skilled surgeon, and has been got into such a condition that the journey does not involve undue risk.  And no rough routine treatment will suffice.  A surgeon is required who can deal with desperate emergencies and pull impossible cases out of the fire—­a young man who does not believe in the impossible, and who can adapt himself to conditions of work that would make an older man shudder, and a man who will never believe what he is told until he has seen it for himself.  For the conditions of work at the front are utterly different from those of civil practice, and it is impossible for any man after many years of regular routine to adapt himself to such changed environment.  The long experience of the older man will be of far more use at the base, and he will have plenty of difficulties to contend with there.

I have often been told that there is no opening for skilled surgery at the front.  In my opinion there is room for the highest skill that the profession can produce.  It is absurd to say that the abdominal cases should be left to die or to recover as best they can, that one dare not touch a fractured femur because it is septic.  To take up such an attitude is simply to admit that these cases are beyond the scope of present surgery.  In a sense, perhaps, they are, but that is all the more reason why the scope of surgery should be enlarged, and not that these cases should be left outside its pale.  I am far from advising indiscriminate operating.  There are many things in surgery besides scalpels.  But I do urge the need for hospitals close to the front, with every modern equipment, and with surgeons of resource and energy.

But for a surgeon this war between nations is only an incident in the war to which he has devoted his life—­the war against disease.  It is a curious reflection that whilst in the present war the base hospital has been given, if anything, an undue importance, in the other war it has been practically neglected.  Our great hospitals are almost entirely field hospitals, planted right in the middle of the battle, and there we keep our patients till such time as they are to all intents and purposes cured.  A very few convalescent homes will admit cases which still require treatment, but only a very few.  The bulk of them expect their inmates to do the work of the establishment.  Now, this is most unreasonable, for a country hospital is cheaper to build and should