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Title: The Australian Army Medical Corps in Egypt - An Illustrated and Detailed Account of the Early - Organisation and Work of the Australian Medical Units in - Egypt in 1914-1915
Author: Barrett, James W., Deane, Percival E.
Language: English
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AUSTRALIAN ARMY
MEDICAL CORPS
IN EGYPT
BARRETT and DEANE
THE AUSTRALIAN ARMY
MEDICAL CORPS IN EGYPT
[Illustration: HELIOPOLIS PALACE HOTEL SHOWING ROTUNDA AND PIAZZAS.
_Frontispiece_]]
THE AUSTRALIAN ARMY
MEDICAL CORPS IN EGYPT
AN ILLUSTRATED AND DETAILED ACCOUNT OF
THE EARLY ORGANISATION AND WORK OF THE
AUSTRALIAN MEDICAL UNITS IN EGYPT
IN 1914-1915
BY
JAMES W. BARRETT
K.B.E., C.M.G., M.D., M.S., F.R.C.S. (ENG.)
TEMPORARY LIEUT.-COL. R.A.M.C.
LATELY LIEUT.-COL. A.A.M.C. AND A.D.M.S. AUSTRALIAN FORCE IN
EGYPT, CONSULTING OCULIST TO THE FORCE IN EGYPT AND REGISTRAR
FIRST AUSTRALIAN GENERAL HOSPITAL; OPHTHALMOLOGIST TO THE
MELBOURNE HOSPITAL, LECTURER ON THE PHYSIOLOGY OF THE SPECIAL
SENSES IN THE UNIVERSITY OF MELBOURNE
AND
LIEUT. P. E. DEANE, A.A.M.C.
QUARTERMASTER FIRST AUSTRALIAN GENERAL HOSPITAL, EGYPT
H. K. LEWIS & CO. LTD.
136 GOWER STREET, LONDON, W.C.1
1918
DEDICATED TO
SIR HENRY AND LADY MACMAHON,
IN GRATEFUL RECOLLECTION
OF THE SERVICES RENDERED BY THEM
TO THE
AUSTRALIAN SICK AND WOUNDED
IN EGYPT
CONTENTS
CHAPTER I
THE AUSTRALIAN ARMY MEDICAL CORPS AT THE OUTBREAK OF WAR
The Call for Hospitals--Appeal to the Medical Profession, and
the Response--Raising the Units pp. 1-10
CHAPTER II
THE VOYAGE OF THE "KYARRA"
Lack of Adequate Preparation--Difficulties of
Organisation--Ptomaine Poisoning pp. 11-18
CHAPTER III
ARRIVAL AND SETTLEMENT IN EGYPT
Disposal of the Hospital Units--Treatment of Camp Cases--The
Acquisition of Many Buildings--Where the Thanks of Australia
are Due pp. 19-31
CHAPTER IV
THE RUSH OF WOUNDED AND RAPID EXPANSION OF HOSPITALS
Saving the Situation--Period of Improvisation--Shortage of
Staff and Equipment--How the Expansion was effected--The Number
of Sick and Wounded pp. 33-54
CHAPTER V
CONVALESCENT DEPOTS
Evacuation of Convalescent Sick and Wounded from Congested
Hospitals--Keeping the Hospitals Free--Libels on the Egyptian
Climate--Discipline pp. 55-65
CHAPTER VI
EVACUATION OF THE UNFIT
Relieving the Pressure on the Hospitals and Convalescent
Depots--Back to Duty or Australia--Methods adopted--Transport
of Invalids by Sea and Train pp. 67-81
CHAPTER VII
SICKNESS AND MORTALITY AMONGST AUSTRALIANS
The Dangers of Camp Life--Steps taken to prevent
Epidemics--Nature of Diseases contracted and Deaths
resulting--Defective Examination of Recruits--Ophthalmic and
Aural Work--The Fly Pest--Low Mortality--The Egyptian Climate
again--Surgical Work and Sepsis--Cholera--Infectious Diseases
pp. 83-111
CHAPTER VIII
VENEREAL DISEASES
The Greatest Problem of Camp Life in Egypt--Conditions in
Cairo--Methods taken to limit Infection--Military and Medical
Precautions--Soldiers' Clubs pp. 113-133
CHAPTER IX
THE RED CROSS WORK
Its Value and Limitations--Origin in Australia--Report of
Executive Officer in Egypt--Red Cross Policy--Defects of Civil
and Advantages of Military Administration--What was actually
done in Egypt pp. 135-185
CHAPTER X
SUGGESTED REFORMS
Defects which became Obvious in War-time--Recommendations to
promote Efficiency--Dangers to be avoided--Conclusion pp. 187-205
CHAPTER XI
POSTSCRIPT
Closure of Australian Hospitals--The Fly Campaign--Venereal
Diseases--Y.M.C.A. and Red Cross--Multiplicity of
Funds--Prophylaxis--Condition of Recruits on Arrival--Hospital
Organisation--The Help given by Anglo-Egyptians pp. 206-234
APPENDIXES
I
Translation of Geneva Convention of July 6, 1906 pp. 237-246
II
Convention for the Adaptation of the Principles of the Geneva
Convention to Maritime War pp. 247-256
INDEX pp. 257-259
LIST OF ILLUSTRATIONS
HELIOPOLIS PALACE HOTEL, SHOWING ROTUNDA AND
PIAZZAS _Frontispiece_
FACING PAGE
MENA CAMP 6
THE S.S. "KYARRA" 14
HELIOPOLIS PALACE HOTEL, SHOWING INFECTIOUS DISEASES CAMP 22
PLAN OF HELIOPOLIS PALACE HOTEL 23
THE MAIN HALL, HELIOPOLIS PALACE HOTEL 24
SURGICAL WARD, HELIOPOLIS PALACE HOTEL 25
HELIOPOLIS PALACE HOTEL: ISOLATION TENTS 26
THE RINK, LUNA PARK, HELIOPOLIS 27
THE CASINO, HELIOPOLIS: INFECTIOUS DISEASES HOSPITAL 29
THE PAVILION, LUNA PARK, HELIOPOLIS 30
THE ATELIER, HELIOPOLIS 37
THE SPORTING CLUB, HELIOPOLIS 40
THE FLEET OF AMBULANCES, HELIOPOLIS 42
THE OPERATING ROOM, HELIOPOLIS PALACE HOTEL 44
UNLOADING THE HOSPITAL TRAIN, HELIOPOLIS SIDING 47
THE LAKE, LUNA PARK, HELIOPOLIS 49
THE SPORTING CLUB, HELIOPOLIS 51
THE SPORTING CLUB, HELIOPOLIS 52
CAIRO AND NEIGHBOURHOOD 58
HELIOPOLIS PALACE HOTEL: CONVALESCENTS ON PIAZZA 59
THE EASTERN MEDITERRANEAN 77
EGYPT, THE DELTA 80
OFFICERS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL 86
HELIOPOLIS PALACE HOTEL: ROTUNDA AND PIAZZAS 97
VENEREAL DISEASES HOSPITAL, ABBASSIA 120
SOLDIERS' CLUB, ESBEKIEH, CAIRO 133
HELIOPOLIS PALACE HOTEL 141
INTERIOR RED CROSS STORE: UTILISATION OF CASES FOR SHELVING 144
RED CROSS BASE DEPOT, HELIOPOLIS 148
HELIOPOLIS SIDING: ARRIVAL OF WOUNDED 166
MATRONS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL 169
SOLDIERS' CLUB, ESBEKIEH, CAIRO 174
N.C.O.S AND MEN, NO. 1 AUSTRALIAN GENERAL HOSPITAL 197
PALACE OF PRINCE IBRAHIM KHALIM (NURSES' HOME) 198
GORDON HOUSE, HELIOPOLIS (NURSES' HOME) 200
AUSTRALIAN CONVALESCENT HOSPITAL, AL HAYAT, HELOUAN 204
INTRODUCTION
The experience of the Australian Army Medical Service, since the
outbreak of war, is probably unique in history. The hospitals sent out
by the Australian Government were suddenly transferred from a position
of anticipated idleness to a scene of intense activity, were expanded in
capacity to an unprecedented extent, and probably saved the position of
the entire medical service in Egypt.
The disasters following the landing at Gallipoli are now well known, and
the following pages will show how well the A.A.M.C. responded to the
call then made upon it.
When the facts are fully known, its achievements will be regarded as
amongst the most effective and successful on the part of the
Commonwealth forces.
In the following pages we have set out the problems which faced the
A.A.M.C. in Egypt, regarding both Red Cross and hospital management, the
necessities which forced one 520-bed hospital to expand to a capacity of
approximately 10,500 beds, and the manner in which the work was done.
The experience gained during this critical period enables us to indicate
a policy the adoption of which will enable similar undertakings in
future to be developed with less difficulty.
We desire to acknowledge gratefully the permission to publish documents
granted by General Sir William Birdwood and Dr. Ruffer of Alexandria,
and also much valuable help given by Mr. Howard D'Egville.
The beautiful photographs which are reproduced were mostly taken by
Private Frank Tate, to whom our best thanks are due.
In any reference to the work of the Australian Army Medical Corps in
Egypt it must never be forgotten that the expansion of No. 1 Australian
General Hospital was effected under the personal direction of the
officer commanding, Lieut.-Colonel Ramsay Smith, who was responsible for
a development probably unequalled in the history of medicine.
The story told is the outcome of our personal experience and
consequently relates largely to No. 1 Australian General Hospital, with
which we were both connected.
CHAPTER I
THE AUSTRALIAN ARMY MEDICAL CORPS AT THE OUTBREAK OF WAR--THE
CALL FOR HOSPITALS--APPEAL TO THE MEDICAL PROFESSION AND THE
RESPONSE--RAISING THE UNITS.
CHAPTER I
Prior to the outbreak of war in August 1914, the Australian Army Medical
Corps consisted of one whole-time medical officer, the Director-General
of Medical Services, Surgeon-General Williams, C.B., a part-time
principal medical officer in each of the six States (New South Wales,
Victoria, and Queensland, South Australia, Western Australia, and
Tasmania), and a number of regimental officers. With the exception of
the Director-General, all the medical officers were engaged in civil
practice, which absorbed the greater portion of their energy.
The system of compulsory military training which came into operation in
1911 was creating a new medical service, by the appointment of Area
Medical Officers, whose functions were to render the necessary medical
services in given areas, apart from camp work. These also were mostly
men in civil practice, to whom the military service was a supplementary
means of livelihood.
Camps were formed at periodical intervals for the training of the
troops, the duration of the camps rarely exceeding a week. At these
camps a certain number of regimental medical officers were in
attendance, and were exercised in ambulance and field-dressing work.
In common with the members of other portions of the British Empire, few
medical practitioners in Australia had regarded the prospect of war
seriously, and in consequence the most active and influential members of
the profession, with some notable exceptions, held aloof from army
medical service.
In 1907, however, owing to the representations of Surgeon-General
Williams, and to the obvious risk with which the Empire was threatened,
senior members of the profession volunteered and joined the Army Medical
Reserve, so that they would be available for service in time of war. The
surgeons and physicians to the principal hospitals received the rank of
Major in the reserve, and the assistant surgeons and assistant
physicians the rank of Captain. Some attempt was made to give these
officers instruction by the P.M.O's, but the response was not
enthusiastic, and little came of it.
At the same time there were a number of medical officers in the
Australian Army Medical Corps who possessed valuable experience of war,
notably the Director-General, whose capacity for organisation evidenced
in South Africa and elsewhere made for him a lasting reputation. The
Principal Medical Officer for Victoria, Colonel Charles Ryan, had served
with distinction in the war with Serbia in 1876, and in the war between
Russia and Turkey in 1877. A fair number of the regimental officers had
seen service in South Africa. The bulk of the medical practitioners
concerned, however, had not only no knowledge of military duty, but
certainly no conception whatever of military organisation and
discipline; and what was still more serious, no real and adequate
realisation of the extraordinary part that can be played in war by an
efficient medical service by prophylaxis.
Such, then, was the position when war was declared.
The response from the people throughout Australia was, as Australians
expected, practically unanimous. They determined to throw in their lot
with Great Britain and do everything that was possible to aid. This
determination found immediate expression in the decision of the
Government of Mr. Joseph Cook, endorsed later by the Government of Mr.
Fisher, to raise and equip a division of 18,000 men and send it to the
front as fast as possible. The system of compulsory military service
entails no obligation on the trainee to leave Australia, and in any
event, the system having been introduced so late as 1911, the trainees
were not available. The expedition consequently became a volunteer
expedition from the outset. Volunteers were rapidly forthcoming, camps
were established in the various States and training was actively begun.
Of the difficulty and delays consequent on the raising of such a
force--of men mostly civilians, of all classes of society, without
clothing, or with insufficient clothing and equipment of all
kinds--little need be said. The difficulties were slowly overcome, and
the force gradually became somewhat efficient. As both officers and men
were learning their business together, the difficulties may well be
imagined. In fairness, however, it should be said that from the physical
and from the mental point of view the material was probably the finest
that could be obtained.
We are, however, only concerned here with the medical aspect of the
movement. The medical establishment was modelled on that of Great
Britain, and consisted of regimental medical officers and of three field
ambulances. The Director-General accompanied the expedition as Director
of Medical Services, and Colonel Chas. Ryan, the Principal Medical
Officer of the State of Victoria, accompanied the expedition as A.D.M.S.
on the staff of General Bridges, the Commander of the Division. Colonel
Fetherston took General Williams's place as Acting Director-General of
Medical Services, and Colonel Cuscaden the place of Colonel Ryan as
Principal Medical Officer of the State of Victoria.
The expedition left in October, a considerable delay having taken place
owing to the necessity of finding suitable convoy, a number of German
cruisers being still afloat and active. It reached Egypt without serious
mishap in December, and at once encamped near the Pyramids at Mena.
There were some difficulties in transit. There was a most extensive
outbreak of ptomaine poisoning on one ship, and measles, bronchitis, and
pneumonia were much in evidence. The mortality was, however, small. The
division on arrival settled down to hard training.
At once difficulties caused by the absence of Lines of Communication
Medical Units became obvious. The amount of sickness surprised those who
had not profited by previous experience. To meet the difficulty Mena
House Hotel was improvised as a hospital and staffed by regimental and
field ambulance officers.
At this stage, however, we can leave the division and return to the
further development of medical necessities in Australia.
[Illustration: MENA CAMP.
_To face page 6_]]
Steps were at once taken in Australia to raise a second division, and
subsequently a third and other divisions in the same manner as the
preceding. As time passed on, the unsuitability of some of the camps and
the lack of medical military knowledge told their tale, and a number of
serious outbreaks of disease took place. It is impossible to give
accurate statistical evidence, but the Australian public seems to have
been shocked that young, healthy, and well-fed men should _in camp life_
have been so seriously damaged and destroyed. The causes as usual were
measles, bronchitis, pneumonia, tonsillitis, and later on a serious
outbreak of infective cerebro-spinal meningitis which was stamped out
with difficulty and took toll (_inter alia_) in the shape of the lives
of three medical men. The sanitation of the Broadmeadows Camp near
Melbourne was not such as to provoke respect or admiration. The camp was
ultimately regarded as unsuitable, and moved to Seymour, pending the
necessary improvements.
It is instructive to note in passing that the Australian public received
a shock when they were first informed of the amount of disease among the
troops in Egypt. Yet it was apparently nothing like so great as that
which existed in Australia, where the usual death-rate is so low. And
yet, had the Service really profited by the lessons of the
Russo-Japanese war, much of the trouble might have been avoided. The
truth of course is that camp life, except under rigorous discipline as
regards hygiene, and the loyal observance of that discipline by each
soldier, is much more dangerous than the great majority of people seem
to imagine. The benefit of the open-air life and of exercise is
counteracted by the chances of infection due to crowding, defective tent
ventilation, the absence of the toothbrush, and other causes.
In September, however, the Imperial Government notified the Australian
Government that Lines of Communication Medical Units were required, and
for the first time the majority of members of the Australian Army
Medical Corps became aware of the nature of Lines of Communication
Medical Units. The Government decided to equip and staff a Casualty
Clearing Station, then called the Clearing Hospital, two Stationary
Hospitals (200 beds each), and two Base Hospitals (each 520 beds). They
were organised on the R.A.M.C. pattern, and the total staff required was
approximately eighty medical officers. Even at this juncture the matter
was not taken very seriously, and there was some doubt as to the nature
of the response. The Director of Medical Services was anxious that the
base hospitals should be commanded and staffed by men of weight and
experience, and accordingly a number of the senior medical consultants
in the Australian cities decided to volunteer. The example was
infectious and there were over-applications for the positions.
The First Casualty Clearing Station was to a great extent raised and
equipped in Tasmania. The First Stationary Hospital was raised and
equipped in South Australia, the Second Stationary Hospital in Western
Australia, and the Second General Hospital in New South Wales. An
exception to this sound territorial arrangement was, however, made in
the case of the First Australian General Hospital--an exception
which proved unfortunate. The commanding officer, a senior
lieutenant-colonel, was resident in South Australia. The hospital
itself was recruited from Queensland, but as the Queensland medical
profession was hardly strong enough to supply the whole of the
medical personnel, most of the consultants, including all the
lieutenant-colonels, were recruited in Victoria. Now Brisbane, the
capital of Queensland, is some 1,200 miles by rail from Melbourne, and
Melbourne about 400 miles by rail from Adelaide, the capital of South
Australia. The result of these arrangements was that the captains and
some of the majors were recruited in Queensland, together with the bulk
of the rank and file and many of the nurses; whilst most of the senior
medical officers, the matron, and a number of nurses were recruited in
Melbourne, and the commanding officer (Lt.-Colonel Ramsay Smith) from
South Australia. He brought with him some seven or eight clerks and
orderlies. Furthermore a number of medical students and educated men
joined in Melbourne. The bulk of the staff was, however, based in
Queensland. This arrangement led to untold difficulties in the way of
recruiting, and it is remarkable that the result should have been as
satisfactory as it was. The equipment was provided partly from
Melbourne, partly from Brisbane, and partly from South Australia. As the
commanding officer was in South Australia, as the registrar and
secretary was in Melbourne, and as the orderly officer was in Brisbane,
some idea of the difficulties can well be imagined--particularly when it
is remembered that with the exception of the commanding officer and a
few officers, the members of the staff had no experience whatsoever of
military matters. Nevertheless an earnest effort was made to secure the
necessary equipment and personnel. In Melbourne great trouble was taken
to secure as many medical students and educated men as could possibly be
obtained.
On the whole the response to the call was more than satisfactory, and
Australian people were of the opinion that a stronger staff could not
have been secured.
It was at first intimated that specialists were not required, but
ultimately after discussion the Government agreed to find the salary of
one specialist. Consequently a radiographer was appointed with the rank
of Major, and another officer was appointed oculist to the hospital with
the rank of honorary Major. Subsequently he was appointed as secretary
and registrar in addition, but without salary or allowances.
The equipment of the hospital was on the R.A.M.C. pattern, and was
supposed to be complete. Furthermore, the Australian branch of the
British Red Cross Society set aside for the use of the hospital one
hundred cubic tons of Red Cross goods which were specially prepared and
labelled at Government House, Melbourne.
CHAPTER II
THE VOYAGE OF THE "KYARRA"--LACK OF ADEQUATE
PREPARATION--DIFFICULTIES OF ORGANISATION--PTOMAINE POISONING.
CHAPTER II
The mode of conveyance of the hospitals to the front next engaged the
attention of the authorities, and negotiations were entered into with
various steamship companies. It was desirable that the hospitals should
be conveyed under the protection of the regulations of the Geneva
Convention.
After some negotiation and the rejection of larger and more suitable
steamers, a coastal steamer, the _Kyarra_, was selected and was fitted
to carry the hospital staff and equipment. The steamer is of about 7,000
tons burden. There were on board approximately 83 medical officers, 180
nurses, and about 500 rank and file, or a total of nearly 800 souls. The
cargo space was supposed to be ample, and 100 tons of space were
promised for the Red Cross stores.
When ready, the _Kyarra_ proceeded to Brisbane and embarked a portion of
the First Australian General Hospital. She then proceeded to Sydney,
embarked the Second Australian General Hospital with its stores,
equipment, and Red Cross goods, and then left for Melbourne, where she
was to embark the remainder of the First Australian General Hospital,
the First Stationary Hospital, and the Casualty Clearing Station.
On arrival at Melbourne, however, it was found that she was carrying
ordinary cargo, that she was not lighted as required by the rules of the
Convention, and that she was already fully loaded. Consequently the
whole of the cargo was taken out of her, the ordinary cargo was removed,
and she was reloaded. It was found, however, that there was no room for
the Red Cross goods belonging to the First Australian General Hospital.
Furthermore, a portion of the equipment which subsequently turned out to
be invaluable, namely 130 extra beds donated to the hospital by a firm
in Adelaide, was nearly left behind. It was only by the exercise of
personal pressure that space was found for this valuable addition at the
last minute. The importance of this donation will be mentioned later in
the story.
Finally, after many delays, the _Kyarra_ left Melbourne on December 5
amidst the goodwill and the blessings of the people, and made her way to
Fremantle, there to embark the Second Australian Stationary Hospital and
its equipment. She finally left Fremantle with this additional hospital,
and made her way across the Indian Ocean.
Lieut.-Col. Martin, Commanding Officer of the No. 2 Australian General
Hospital, was promoted to the rank of Colonel for the voyage only. He
was promoted for the purpose of placing him in command of the troopship.
The voyage of the _Kyarra_ involved calls at Colombo, Aden, Suez, Port
Said, and Alexandria. Those on board believed in the first instance they
were proceeding to France, and when they arrived at Alexandria, and
found they were all destined for Egypt, many expressed feelings of keen
disappointment on the ground that they would have no work to do. They
were soon, however, to be undeceived.
[Illustration: THE S.S. "KYARRA."
_To face page 14_]]
The voyage itself does not call for lengthy comment. The ship was
unsuitable for the purpose for which she had been chartered. She was
small, overcrowded, and not as clean or sanitary as she might have been.
Her speed seemed to decrease, and was scarcely respectable at any time;
there were apparently breakdowns of the engines; and the food supplied
to the officers and nurses was not infrequently inferior in quality and
in preparation. In consequence an outbreak of ptomaine poisoning took
place, and twenty-two officers and others were infected, two of them
seriously.
The arrangements at the men's canteen had not been fully thought out,
and in the Tropics it was not possible to obtain fruit of any
description. Fresh or tinned fruits were not kept in stock. There was
some tinned meat and fish, but the men could obtain nothing to drink
except a mixture made from Colombo limes and water.
There was a certain amount of illness apart from ptomaine poisoning, and
amongst the cases treated were bronchitis, influenza, tonsillitis, and
eye disease. Five cases reacted severely to anti-typhoid inoculation,
and required rest in hospital.
On the whole, officers, nurses, and men took the voyage seriously, and
did their best to learn something of their work. The officers were
drilled, the nurses gave lessons to the orderlies, and systematic
lectures were given by the officers. An electric lantern had been
provided by the O.C., and lantern lectures were given regularly during
the voyage.
The quarters provided in the fore part of the ship for the men were
certainly insanitary, and to an extent dangerous. Towards the end of the
voyage many cases of rotten potatoes were thrown overboard, having been
removed from beneath the quarters occupied by the men. With Red Cross
aid, however, provided by the Queensland branch, fans had been
installed, and an attempt made to render these quarters more sanitary
and habitable. A portion of the deck could not be used because of leaky
engines, and neither request nor remonstrance enabled those concerned to
get these leaks stopped.
The following measurements show what trouble so simple a fault can
cause. In the tropics the wet portion of the deck could not of course be
used for sleeping purposes.
APPROXIMATE DECK SPACE AVAILABLE FOR NO. 1
GENERAL AND NO. 2 STATIONARY HOSPITALS
ON FORE DECK
sq. ft.
Approximate deck space available 1,920
Space obtainable on hatches 288
-----
2,208
Space permanently wet through leaking
engines 648
-----
Approximate net 1,560
As the number of men occupying these quarters (including sergeants and
warrant officers) was about 300, the space available approximated 5 sq.
ft. per man.
Notwithstanding these conditions, the usual peculiarity of Anglo-Saxon
human nature showed itself when at the end of the voyage the officers
were required to sign the necessary certificates stating that the
catering had been satisfactory. Only three refused to sign; the
remainder signed, mostly with qualifications.
The manner in which the average Australian makes light of his
misfortunes was strikingly illustrated on one occasion. A long, mournful
procession of privates slowly walked around the deck. In front, with
bowed head, was a soldier in clerical garb, an open book in his hand.
Immediately behind him were four solemn pall-bearers, carrying the day's
meat ration, which is stated to have been "very dead." Apparently the
entire ship's company acted as mourners. The procession wended its way
to the stern, where an appropriate burial service was read; the ship's
bugler sounded the "last post," and the remains were committed to the
deep. Needless to say the usual formality of stopping the ship during
the burial service was not observed on this occasion. An attempt to
repeat the performance was fortunately stopped by those in authority,
and all subsequent "burials" were strictly unceremonious.
Those who go to war must expect to rough it, but on a peaceful ocean,
secure from the enemy, and in a modern passenger ship, it should be
possible to provide food which does not imperil those who consume it,
and also to ensure reasonable comfort.
With reference to the defects of the ship it should be said that when
the _Kyarra_ was chartered Australians had not realised the colossal
nature of the war, and had not begun to think on a large scale, and
those responsible had neither tradition nor experience to guide them.
Furthermore the commander and officers of the _Kyarra_ courteously did
their best, but it was evident they understood the difficulty of
transforming a coastal steamer into a Hospital Transport.
The Geneva Convention does not seem to be fully understood, and
experience shows what complicated conditions arise, and how easy it is
to commit an unintentional breach of the Regulations. But in war there
can be no excuses.
CHAPTER III
ARRIVAL AND SETTLEMENT IN EGYPT--DISPOSAL OF THE HOSPITAL
UNITS--TREATMENT OF CAMP CASES--THE ACQUISITION OF MANY
BUILDINGS--WHERE THE THANKS OF AUSTRALIA ARE DUE.
CHAPTER III
On arrival at Alexandria, there seemed to be no great hurry in
disembarking, and many of the older medical officers were fully
persuaded that the units were not wanted in France; that there was very
little to do in Egypt; and that if their services were not required it
would be fairer to inform them of the fact, and let them go home again.
They were soon to be undeceived. A message was received asking the O.C.s
of the various units to visit Cairo, where they waited on
Surgeon-General Ford, Director of Medical Services to the Force in
Egypt. They were informed that there was more than enough work for all
these Lines of Communication Medical Units in Egypt.
The First Australian General Hospital was to be placed in the Heliopolis
Palace Hotel at Heliopolis. The Second Australian General Hospital was
to take over Mena House and release the regimental medical officers and
officers of the Field Ambulances from the hospital work they were doing.
The First Stationary Hospital was to be placed with the military camp at
Maadi, and the Second Australian Stationary Hospital was to go into camp
at Mena and undertake the treatment of cases of venereal diseases. The
First Casualty Station was temporarily lodged in Heliopolis, and then
sent to Port Said to form a small hospital there in view of the
imminent fighting on the Canal. These dispositions were made as soon as
possible.
It should be noted at this juncture that the bulk of the Australian
Forces, namely the First Division, was camped at Mena. A certain
quantity of Light Horse was encamped at Maadi, whilst the Second
Division, composed chiefly of New Zealanders, was encamped near
Heliopolis. New Zealand had not provided any Lines of Communication
Units, but her sick had been accommodated at the British Military
Hospital, Citadel, Cairo, and also at the Egyptian Army Hospital,
Abbassia.
The First and Second Stationary Hospitals used their tents for the
respective purposes. The Casualty Clearing Station utilised a building
assigned to it in Port Said.
Some description is required, however, of the Heliopolis Palace Hotel.
This, as the photograph shows, is a huge hotel de luxe, consisting of a
basement and four stories.
It was arranged that the kitchens, stores, and accommodation for rank
and file should be placed in the basement. The first floor was allotted
to offices and officers' quarters; a wing of the third floor provided
accommodation for nurses, and the only portions of the building used at
first for patients were the large restaurant and dining-room, and the
billiard recesses, _i.e._ the Rotundas and Great Hall.
The hospital when fully developed required a large staff. The two large
wards in the Rotundas and Central Hall could be administered easily
enough, but the rest of the hotel consisted of rooms holding from three
to six beds. The doors were removed. There were fortunately many
bathrooms and lavatories. The rooms are very lofty, and provided with
very large windows, but there are no fanlights over the doors, so that
if doors were left in place ventilation was inadequate. A good deal of
difficulty was experienced in providing suitable slop hoppers and sinks,
places for cleaning bed-pans and the like, but little by little suitable
arrangements were made.
[Illustration: HELIOPOLIS PALACE HOTEL, SHOWING INFECTIOUS DISEASES CAMP.
_To face page 22_]]
[Illustration: PLAN OF HELIOPOLIS PALACE HOTEL.
_To face page 23_]]
The Arab servants, employed to ease the pressure on the staff, were
housed in tents in one part of the grounds, and some of the rank and
file in tents in another part. Others, for a short period, slept on the
roof. The accommodation in general of the rank and file was excellent.
The kitchens were a source of difficulty as the ranges were so
elaborate; the hot-water service was unsatisfactory because of failure
of fuel due to war conditions. Still, by one device and another, smooth
running was ultimately secured.
When full value is given to all adverse criticism, it must be admitted
that few better surgical hospitals could have been obtained.
The Officer Commanding the hospital (Lt.-Colonel Ramsay Smith) visited
it with the Registrar, and made the preliminary arrangements. He then
returned to Alexandria to supervise the disembarkation. Meanwhile the
Registrar spent his time interviewing the proprietors, the D.M.S., and
others concerned.
Only those who, knowing nothing of military organisation, tackle a job
of the kind can fully appreciate the bewilderment caused by the mystic
letters A.D. of S. and T., D.A.A. and Q.M.G., and the like, with all
they connote. The Imperial officers saw the difficulties and were
kindly and helpful to a remarkable degree.
The hospital was opened on January 25, with provision for 200 patients.
The first patient to be admitted was suffering from eye disease. An
ophthalmic department was opened on the first floor, providing
accommodation for out-patients as well as in-patients. As there were few
oculists and aurists in Egypt at this juncture other than those at this
hospital, the department rapidly assumed formidable proportions. The
solid floors, lofty rooms, shuttered windows, and provision of electric
light lent themselves to the creation of an excellent ophthalmic
department.
The number of soldiers within easy distance of Heliopolis was not very
great. Nevertheless patients, mostly medical cases, made their
appearance in steadily increasing numbers, especially as Mena House was
soon filled, and was limited in its accommodation.
With the arrival of the Second Australian Division in Egypt, and of
subsequent reinforcements, the pressure on the First Australian General
Hospital intensified, since these new arrivals went into camp at or near
Heliopolis. The hotel rooms were filled with valuable furniture,
including large carpets. From the outset it was arranged that neither
carpets nor curtains were to be retained, and that the only hotel
furniture which was to be used was beds and bedding for the officers and
nurses. Everything else was stored away in various rooms. Up to this
period the belief in official circles was that the First Australian
General Hospital would soon be moved to France, and that it was
consequently unwise to expand further, or to spend any considerable sum
of money. The pressure, however, steadily continued, and when the
Dardanelles campaign commenced, orders were given for the immediate
expansion of the hospital to meet the ever-growing requirements of the
troops. In order to effect this development the whole of the hotel
furniture was moved into corridors of the building. Subsequently it was
taken from the building and stored elsewhere, a difficult proceeding
involving a great deal of labour.
[Illustration: THE MAIN HALL, HELIOPOLIS PALACE HOTEL.
_To face page 24_]]
[Illustration: SURGICAL WARD, HELIOPOLIS PALACE HOTEL.
_To face page 25_]]
VENEREAL AND INFECTIOUS DISEASES CAMP
On February 7 a New Zealand Field Ambulance which had taken charge of
the venereal cases in camp, nearly 250 in number, was summarily ordered
to the Suez Canal. Orders were given on that evening at 9 p.m. that the
tent equipment of the First Australian General Hospital was to be
erected at the Aerodrome Camp (about three-quarters of a mile distant),
and that the hospital was to staff and equip a Venereal Diseases Camp by
2 p.m. the following day. By this time, too, large numbers of cases of
measles had made their appearance, and it was quite clear that some
provision must be made for these and other infectious cases. Accordingly
another camp was pitched alongside the Venereal Camp for the
accommodation of those suffering from infectious diseases. By direction
of the D.M.S. Egypt, a senior surgeon was appointed to command the camp,
and was given the services of two medical officers, one in connection
with the venereal cases, and one in connection with the infectious
cases. Definite orders were given that such cases were not to be
admitted into the General Hospital.
The camp was no sooner pitched than it was filled, and the demand on the
accommodation for venereal and other cases rose until upwards of 400
venereal cases, and 100 infectious cases--chiefly measles--were provided
for. A good deal of difficulty was experienced in suitably providing for
the serious measles cases in camp, and accordingly a limited number of
tents were erected in the hospital grounds, and a small camp was formed
in that position, and placed under the charge of a nursing sister. To
this camp all serious cases of infectious disease, and all cases with
complications, were immediately transferred. It may be said in passing
that the cases treated in this way did exceedingly well.
The number of venereal cases would have wholly out-stepped the
accommodation had it not been for the policy adopted by the D.M.S.
Egypt. All venereal cases not likely to recover rapidly were sent back
to Australia, or (on one occasion) to Malta.
ACQUISITION OF MANY BUILDINGS
The hospital, then, at this juncture consisted of the main building, in
which the accommodation was being steadily extended by the utilisation
of all the rooms, and of the venereal and infectious diseases camp.
[Illustration: HELIOPOLIS PALACE HOTEL: ISOLATION TENTS.
_To face page 26_]]
[Illustration: THE RINK, LUNA PARK, HELIOPOLIS.
_To face page 27_]]
The first khamsin, however, which blew warned every one concerned that
patients could not be treated satisfactorily in tents in midsummer. At
the request of the medical officer in charge, two rooms in one wing of
the main building were given over to bad infectious cases, and the camp
in the grounds was abolished. The arrangement was unsatisfactory. The
cases did not do as well as might have been desired, though this was
attributed to an alteration in their type; and renewed efforts were made
to devise a better arrangement. Finally a portion of the Abbassia
barracks was obtained, and converted into an excellent venereal diseases
hospital to which the venereal cases were transferred.
The Mena camp had been struck, and the troops sent to the Dardanelles;
the First and Second Stationary hospitals had moved to Mudros; and the
First Casualty Clearing Station had been transferred to the Dardanelles.
Consequently the pressure fell almost entirely on the First General
Hospital, and the Venereal Diseases Hospital thus became the only
Venereal Diseases Hospital in Egypt.
Close to the Palace Hotel there was a large pleasure resort, known as
the Luna Park, at one end of which was a large wooden skating-rink,
enclosed by a balcony on four sides. This building was obtained, and was
railed off from the rest of Luna Park by a fence 13 feet high. The
infectious cases from the camp were then transferred to it. A camp
kitchen was built, and an admirable open-air infectious diseases
hospital was obtained. It became obvious, however, that the
skating-rink, which with the balcony could accommodate, if necessary,
750 patients, might better serve as an overflow hospital in case of
emergency, and accordingly efforts were made to obtain another
infectious diseases hospital in the vicinity.
Eventually a fine building known as the Race Course Casino, a few
hundred yards from the Heliopolis Palace, was obtained and converted
into an infectious diseases hospital providing for the accommodation of
about 200 patients. With its ample piazzas and excellent ventilation it
formed an ideal hospital, and was reluctantly abandoned at a later date
owing to the development of structural defects which threatened its
stability.
The position, then, at this stage was that the First Australian General
Hospital consisted of (1) the Palace Hotel, ever increasing in its
accommodation as the furniture was steadily removed and space
economised, its magnificent piazzas utilised, and tents erected in the
grounds for the accommodation of the staff; of (2) the rink at Luna
Park, which was now empty and ready for the reception of light cases
overflowing from the Palace; of (3) the Casino next door to Luna Park,
which had now become an infectious diseases hospital; and of (4) the
Venereal Diseases Hospital at Abbassia, which soon became an independent
command though still staffed from No. 1 General Hospital.
[Illustration: THE CASINO, HELIOPOLIS: INFECTIOUS DISEASES HOSPITAL.
_To face page 29_]]
PREPARATION IN ANTICIPATION
At or shortly before this period, however, the authorities had become
aware that wounded might be received from the Dardanelles at some future
date in considerable numbers, which could not, however, be accurately
estimated. Accordingly a consultation was held between Surgeon-General
Ford and Surgeon-General Williams (who arrived in Egypt in February),
Colonel Sellheim, who was the officer commanding the newly formed
Australian Intermediate Base, the O.C. of the First Australian General
Hospital, Lieut.-Col. Ramsay Smith, and Lieut.-Col. Barrett. It was
decided to authorise the expenditure of a considerable sum of money in
making the necessary preparation, on the ground that if the wounded did
not arrive the Australian Government would justify this action, and that
if the wounded did arrive a reasonable attempt would have been made to
meet the difficulty. Instructions were accordingly given to buy up beds,
bedding, and equipment, which would _inter alia_ provide at least
another 150 beds in the Infectious Diseases Hospital and 750 in the
rink. At first iron beds were purchased, but it was impossible to obtain
deliveries of iron beds at a rate exceeding 120 a week, and there were
(practically) none ready made in Egypt. It was during this period of
expansion that the donation of 130 beds made to Lieut.-Col. Ramsay Smith
in Adelaide proved to be so useful.
It was, therefore, quite certain that full provision could not be made
in time if iron beds were to be used, and accordingly large purchases of
palm beds were made. These are very strong, stoutly constructed beds,
made of palm wood. They are quite comfortable and last for several
months. The drawback is that they are liable ultimately to become
vermin-infected and that their sharp projecting struts are very apt to
catch the dresses of those who pass by. We were able, however, to obtain
them with mattresses at a rate exceeding 100 a day. They were ordered
in practically unlimited numbers, so that shortly there was
accommodation for the 900 patients referred to. In addition a large
reserve of beds and mattresses had been created so that they could be
placed in the corridors if it became necessary.
At an earlier date the project of taking the whole of Luna Park and
using the upper portion of it, the Pavilion, as well as the lower
portion, the Rink, had been under contemplation, but had been rejected
on the ground of expense. The rental demanded was high, owing to the
fact that the park must perforce be closed as a pleasure resort if used
as a hospital.
The conveyance of sick and wounded from Cairo to Heliopolis next engaged
attention, and on April 26 it was found possible to run trains from
Cairo on the tram-lines to Heliopolis Palace Hotel. A trial run was made
about midnight on the 27th. The first train containing sick from Mudros
arrived on the evening of the 28th, and on the 29th and 30th without
warning the wounded poured into Heliopolis.
As soon as the nature of the engagement at the Dardanelles became known,
the D.M.S. Egypt ordered that the whole of Luna Park be taken over and
immediately equipped. The pavilion was made ready for the reception of
the wounded within a very few hours, and in a few days Luna Park was so
equipped with baths, latrines, beds, bedding, etc., that it could
accommodate 1,650 patients.
[Illustration: THE PAVILION, LUNA PARK, HELIOPOLIS.
_To face page 30_]]
Never before in history were precautions better justified. Had the
expenditure not been incurred, had the representative of the Australian
Government held up the execution of the policy of preparation by waiting
for instructions, a disaster would have occurred, and many wounded would
have been treated in tents in the sand of the desert. Yet so strangely
constituted is a minor section of humanity that instead of satisfaction
being expressed that the best possible had been done, some criticism was
levelled at the undertaking on the ground that it was not at the outset
technically perfect, and that it showed the initial defects inseparable
from rapid improvisation. The Australian people should be profoundly
grateful to Surgeon-General Williams and Colonel Sellheim, whose
decisive promptitude enabled the position to be saved.
CHAPTER IV
THE RUSH OF WOUNDED AND RAPID EXPANSION OF HOSPITALS--SAVING THE
SITUATION--PERIOD OF IMPROVISATION--SHORTAGE OF STAFF AND
EQUIPMENT--HOW THE EXPANSION WAS EFFECTED--THE NUMBER OF SICK
AND WOUNDED.
CHAPTER IV
During the first ten days of the crisis approximately 16,000 wounded men
entered Egypt, of whom the greater number were sent to Cairo, and during
those ten days an acute competition ensued between the supply of beds
and the influx of patients. Fortunately the supply kept ahead of the
demand, the pressure being eased by the immediate provision at Al Hayat,
Helouan, of a convalescent hospital capable of accommodating 1,000 and
in an emergency even 1,500 patients.
At the end of the ten days referred to, the position was as follows:
Heliopolis Palace Hotel had expanded to 1,000 beds, Luna Park
accommodated 1,650 patients, the Casino would accommodate 250, the
Convalescent Hospital, Al Hayat, Helouan, was accommodating 700, and if
need be could accommodate 1,500 patients, and the Venereal Diseases
Hospital could receive 500 patients.
In the meantime No. 2 General Hospital had been transferred to Ghezira
Palace Hotel, which was rapidly equipped, and at a later date became
capable of receiving as many as 900 patients. Mena House remained an
overflow hospital, bearing the same relation to No. 2 General Hospital
as the Auxiliary Hospitals at Heliopolis bore to No. 1 General
Hospital.
It was quite evident, however, that the accommodation was still
insufficient, and a further search was made for other buildings. At this
juncture a building opposite Luna Park known as the Atelier was offered
by a Belgian firm for the use of the sick and wounded. It consisted of a
very large brick building, with a stone floor and a lofty roof, which
had been used as a joinery factory. At first the idea was entertained of
creating a purely medical hospital, and of keeping the Heliopolis Palace
for heavy surgery, with the auxiliaries for lighter cases. This policy
was found to be impracticable, and the Atelier was converted into a
400-bed auxiliary hospital similar in character to Luna Park.
It was open for the reception of patients on June 10, and on the 11th
was practically full of wounded.
As it was evident that the accommodation was still insufficient, a
further search was made, and the Sporting Club pavilion, a building in
the vicinity of the Heliopolis Palace, was taken over, and converted
into a hospital of 250 beds. It was at first intended to use it as an
infectious diseases hospital. As, however, it possessed great
possibilities of expansion if suitable hutting could be erected, another
infectious diseases hospital was sought elsewhere, and wooden shelters
were erected. The accommodation of the Sporting Club was raised by this
means to 1,250 beds.
[Illustration: THE ATELIER, HELIOPOLIS.
_To face page 37_]]
The heat of summer was coming on, and the necessity for providing
seaside accommodation for the convalescents from Cairo became obvious.
Consequently the Ras el Tin school at Alexandria was taken by No. 1
General Hospital, and turned into an excellent convalescent hospital for
500 patients. It consisted of a very large courtyard, surrounded by
(mostly) one-story buildings, and was about 400 yards from the sea. In
the courtyard a Recreation Tent, provided by the British Red Cross
Australian Branch, was erected by the Y.M.C.A. The whole formed an
admirable seaside convalescent hospital.
But even now the accommodation was not sufficient, and by direction the
Grand Hotel, Helouan, was acquired, and converted into an additional
convalescent hospital for 500 patients. This institution, however, was
shortly afterwards transferred to the Imperial authorities and used for
British troops.
The structural defects in the Casino or Infectious Diseases Hospital,
and the undesirability of using the Sporting Club for this purpose,
necessitated the erection of an Infectious Diseases Hospital elsewhere.
A beautifully constructed private hospital, the Austrian Hospital at
Choubra, was commandeered and staffed by the First Australian General
Hospital, and provided 250 beds. This hospital also was, however, soon
transferred to the Imperial authorities, and administered as a British
hospital.
As the demand for accommodation for infectious cases increased, the
artillery barracks at Abbassia were taken over by the Australian
authorities, and converted into an Infectious Diseases Hospital which
ultimately accommodated 1,250 patients.
The needs continuing to press, the Montazah Palace at Alexandria was
offered by His Highness the Sultan to Lady Graham as a convalescent
hospital. The offer was gratefully accepted by the combined British and
Australian Branches of the Red Cross Society. It is the only hospital
in Egypt in the administration of which the Australian Red Cross takes
part.
In addition to these major activities, there were many other minor
changes. The introduction of cholera from Gallipoli was feared, and in
the grounds of the Casino a cholera hospital was erected in anticipated
need, under the direction of the Board of Public Health, Egypt.
Fortunately it was never required, but it was ready for use, and would
have been staffed by the First Australian General Hospital.
The final result, then, of all these expansions was as follows. The
520-bed hospital which landed in Egypt on January 25 had expanded into:
Beds
Heliopolis Palace Hotel 1,000
Luna Park 1,650
Atelier 450
Sporting Club 1,250
Choubra Infectious 250
Abbassia Infectious 1,250
Venereal Diseases, Abbassia 2,000
Al Hayat, Helouan (Convalescent) 1,250
Ras el Tin (Convalescent) 500
Montazah Palace (Convalescent, Australian moiety) 500
Grand Hotel, Helouan 500
------
(Approximately) 10,600
======
Almost the whole of this work was undertaken by the staff originally
intended to manage a 520-bed hospital, at all events until the latest
developments. Reinforcements did not arrive until June 15, and even then
they were not long available.
To house the reinforcements of nurses two other buildings were taken at
Heliopolis: Gordon House, opposite Luna Park, and the Palace of Prince
Ibrahim Khalim, on the outskirts of Heliopolis.
It will be noted that the greater part of the expansion took place in
the immediate vicinity of the Palace Hotel. This step was alike
deliberate and necessary, for reasons that will be explained hereafter.
METHODS ADOPTED IN ORGANISING HOSPITALS
The methods adopted in organising these hospitals varied. In the first
instance Lieut.-Col. Barrett was deputed by the D.M.S. Egypt to seek for
the necessary buildings, and when these were approved to negotiate with
the owners respecting the rent. This proceeding proved very tedious and
difficult, and in pursuance of a General Army Order another and simpler
plan was adopted by the appointment of an arbitration commission under
the chairmanship of Sir Alexander Baird. To this commission the
determination of rent and compensation was referred when the acquisition
of the buildings received the sanction of the Commander-in-Chief. It
need hardly be said that a good deal of tact was necessary in these
proceedings, and every attempt was made to meet the wishes of owners
with regard to the buildings commandeered.
Up till June 15 the number of nurses available was small, and it became
quite obvious that, owing to the rush of sick and wounded, and the hot
weather, some of the nurses would experience a breakdown. Lieut.-Col.
Barrett accordingly visited Alexandria, and arranged with the Australian
and Egyptian branches of the British Red Cross Society to take over and
equip two buildings as Rest Homes. These houses had been generously
offered for this purpose to Her Excellency Lady MacMahon, wife of the
High Commissioner for Egypt. One of these buildings was a large house
belonging to a distinguished Egyptian and was situated in Ramleh, not
very far from the beach, and the other was about eight miles from
Alexandria at Aboukir Bay, the site of Nelson's victory. The latter
consisted of a large seaside bungalow owned by Mr. Alderson, with an
excellently fitted house-boat anchored some little distance from the
shore.
The Australian Government undertook to pay for the maintenance of the
nurses in these homes, which were placed under the management of a joint
committee of the two branches of the Red Cross Society, under the
presidency of Lady MacMahon. Nurses were then sent to these homes for a
week at a time, and derived great benefit from the sea-bathing. These
vacations formed a welcome and healthy break in work of excessive
severity.
The following table indicates the dates of the principal changes which
took place in the First Australian General Hospital.
CHRONOLOGY OF THE FIRST AUSTRALIAN GENERAL HOSPITAL
January 14.--Arrived at Alexandria.
January 24.--Arrived at Heliopolis.
February 7.--Established Aerodrome Camp.
April 6.--Luna Park taken over.
April 19.--Established Venereal Hospital, Abbassia.
April 26.--The Casino taken over.
April 29.--Arrival of wounded.
May 1.--Prince Ibrahim Khalim's Palace taken over.
May 5.--Al Hayat Hotel taken over.
May 26.--The Atelier taken over.
May 27.--Gordon House taken over.
June 10.--Sporting Club taken over.
[Illustration: THE SPORTING CLUB, HELIOPOLIS.
_To face page 40_]]
THE POLICY OF EXPANSION
It has frequently been said in criticism of the Auxiliary Hospitals that
it would have been better to have taken over Shepheard's Hotel, or the
Savoy. Neither Shepheard's nor the Savoy (particularly the former) is
very suitable for hospital purposes, since hotels containing a large
number of small rooms involve much labour, and consequently a large
staff, and the authorities were faced with the fact that there was no
staff available. Surgeon-General Williams had cabled to Australia for
reinforcements long before the crisis, but the reinforcements did not
arrive until the middle of June. Clearly the sound policy was to obtain
buildings as close to Heliopolis as possible, to administer them with a
small staff, and to use them as overflow hospitals. Shepheard's or the
Savoy would have required a very large staff, and it was not existent.
Even at Helouan the employment of civilians as officers was necessary in
order to carry on. Arab servants were extensively employed by reason of
the shortage of staff. They acted as menservants, sweepers, and the
like.
MOTOR AMBULANCES
When the _Kyarra_ arrived in Egypt the British authorities did not
possess any motor transport. There were some motor ambulances belonging
to the New Zealand authorities and a few motor ambulances which
accompanied the hospitals on the _Kyarra_, and which had been allotted
to special units. It became obvious, however, that units might be placed
in circumstances in which they did not require their ambulances, and
others in circumstances in which they required more than their share;
and accordingly Surgeon-General Williams decided to park the whole of
these motor ambulances in two garages, a major one at Heliopolis and a
smaller one at Ghezira, near No. 2 General Hospital. The garage at
Heliopolis held at least thirty motor ambulances. It belonged to the
Heliopolis Palace Hotel, and was equipped and furnished with a repairing
plant at the expense of the Australian branch of the British Red Cross.
The Ghezira garage was dealt with in like manner, and in addition the
rent was paid in the first instance by the Australian branch of the
British Red Cross. The organisation of these garages involved
considerable difficulty. The drivers employed were not recruited by the
Commonwealth Government as belonging to the motor transport, since there
was not any motor ambulance establishment, and they consequently only
received the ordinary private's pay. Furthermore promotions were very
difficult to effect. Nevertheless they saved the position. For a long
while Egypt was absolutely dependent on these motor fleets for the
removal of the sick and wounded, British or Australian. The work was
excessive but the drivers responded splendidly. Difficulties arose
through different units endeavouring to commandeer motor ambulances for
their own use. This was met by a decision of the D.M.S. Egypt that
ambulances were to be kept in the garages, and telephoned for when
necessary. From the outset, the lack of runabout motors was severely
felt, and ambulances were frequently employed for purposes which would
have been better effected by runabouts.
[Illustration: THE FLEET OF AMBULANCES, HELIOPOLIS.
_To face page 42_]]
THE ARRIVAL OF THE SICK AND WOUNDED FROM THE FRONT
The end of April was reached. The bulk of the forces had disappeared
from Egypt, and their position was only known by rumour; the hospital
was gradually emptied of patients; Mena Camp had been abandoned, and
Maadi Camp was reduced to small proportions. The weather was beautiful,
and any one might have been easily lulled into a sense of false
security. On April 28, however, a train-load of sick arrived. Its
contents were not known until it arrived at the Heliopolis siding. The
patients had come from Mudros, and numbered over 200 sick, including
some 60 venereal cases, a matter of some interest in the light of
subsequent events.
On the following day, however, without notice or warning of any
description, wounded began to arrive in appalling numbers. On April 30
and May 1 and 2 no less than 1,352 cases were admitted at Heliopolis.
The expansion already indicated at Luna Park was at once effected, and
some relief was obtained by transferring the lighter cases to Mena
House--some seventeen miles distant. The last train-load of wounded
arrived in the early morning of May 2, and deserves special notice, as
many of the men were very seriously injured. There were about 100 cases;
the train arrived at midnight, and was emptied by 4 o'clock in the
morning. The bearing of the men badly injured was past praise. At 4
a.m. the main operating-room of the hospital bore eloquent testimony to
the gravity of the work, which had been going on for many hours, and the
exhausted condition of the staff further demonstrated what had occurred.
The staff at the hospital was quite inadequate to cope with the rush,
notwithstanding the willingness of every one concerned, and accordingly
volunteers from some of the Field Ambulances, and from the Light Horse
units which were still in Egypt, were called for and readily obtained.
With the aid of the volunteers and by dint of universal devotion to duty
the work was done, and on the whole done well.
The following table shows the staff available from April 2 to August 18,
and the work required of it:
STAFF, ETC., OF NO. 1 GENERAL HOSPITAL AT HELIOPOLIS, INCLUDING
AUXILIARY HOSPITALS
--------+---------+--------+---------+----------+-------
Date. |Officers.| Nurses.| Rank and| Patients.| No. of
| | | File. | | Beds.
--------+---------+--------+---------+----------+-------
April 25| 28 | 92 | 163 | 495 | 893
26| 29 | 92 | 187 | 504 | 893
27| 28 | 92 | 184 | 479 | 897
28| 28 | 92 | 184 | 479 | 895
29| 28 | 92 | 197 | 631 | 925
30| 28 | 92 | 204 | 1,082 | 1,100[1]
May 1| 26 | 92 | 216 | 1,324 | 1,100
2| 26 | 92 | 236 | 1,465 |
3| 32 | 92 | 236 | 1,425 |
4| 28 | 109 | 221 | 1,427 |
5| 30 | 107 | 221 | 1,389 |
6| 30 | 107 | 209 | 1,362 | 2,108
7| 30 | 107 | 198 | 1,353 |
8| 30 | 107 | 198 | 1,454 |
9| 29 | 107 | 201 | 1,432 |
10| 26 | 107 | 201 | 1,485 |
11| 26 | 107 | 209 | 1,618 | 2,493
[Illustration: THE OPERATING ROOM, HELIOPOLIS PALACE HOTEL.
_To face page 44_]]
--------+---------+--------+---------+----------+-------
Date. |Officers.| Nurses.| Rank and| Patients.| No. of
| | | File. | | Beds.
--------+---------+--------+---------+----------+-------
May 12| 26 | 107 | 209 | 1,846 | 2,487
13| 28 | 107 | 249 | 2,293 | 2,592
14| 29 | 107 | 244 | 2,302 | 2,726
15| 29 | 107 | 244 | 2,218 | 2,705
16| 32 | 107 | 261 | 2,208 | 2,679
17| 30 | 107 | 259 | 2,165 | 2,646
18| 30 | 107 | 252 | 2,187 | 2,940
19| 30 | 107 | 274 | 1,911 |
20| 30 | 107 | 302 | 1,904 |
21| 29 | 107 | 290 | 1,889 |
22| 29 | 107 | 287 | 1,856 |
23| 29 | 107 | 287 | 1,812 |
24| 29 | 104 | 287 | 1,811 |
25| 32 | 104 | 299 | 1,777 |
26| 32 | 104 | 295 | 1,768 |
27| 32 | 104 | 295 | 1,805 |
28| 32 | 104 | 317 | 1,781 |
29| 35 | 143 | 319 | 1,931 |
30| 35 | 143 | 322 | 1,918 |
31| 35 | 143 | 322 | 1,820 |
June 1| 35 | 143 | 322 | 1,876 |
2| 35 | 143 | 315 | 1,873 |
3| 36 | 143 | 314 | 1,869 |
4| 36 | 147 | 277 | 1,866 |
5| 35 | 147 | 277 | 1,872 |
6| 36 | 147 | 264 | 1,786 |
7| 36 | 147 | 264 | 1,627 |
8| 34 | 147 | 253 | 1,709 |
9| 34 | 147 | 253 | 2,474 | 2,805
10| 32 | 133 | 247 | 2,211 |
11| 32 | 133 | 247 | 2,605 |
12| 32 | 133 | 262 | 2,375 |
13| 32 | 133 | 263 | 2,384 |
14| 34 | 133 | 264 | 2,324 |
15| 34 | 133 | 264 | 2,324 |
16| 54[2] | 171[3]| 463[4]| 2,269 |
17| 54 | 171 | 463 | 2,328 |
18| 55 | 165 | 462 | 2,259 |
19| 55 | 165 | 449 | 2,266 |
20| 55 | 165 | 443 | 2,339 |
21| 55 | 165 | 439 | 2,335 |
22| 55 | 165 | 439 | 2,357 |
--------+---------+--------+---------+----------+-------
Date. |Officers.| Nurses.| Rank and| Patients.| No. of
| | | File. | | Beds.
--------+---------+--------+---------+----------+-------
June 23| 55 | 165 | 439 | 2,159 |
24| 55 | 165 | 438 | 2,157 |
25| 55 | 163 | 438 | 2,003 |
26| 55 | 163 | 429 | 1,926 |
27| 55 | 163 | 429 | 1,887 |
28| 55 | 163 | 429 | 2,121 |
29| 54 | 163 | 429 | 2,150 |
30| 55 | 163 | 429 | 2,135 |
July 1| 55 | 163 | 430 | 2,332 | 2,956
2| 58 | 163 | 430 | 2,305 |
3| 58 | 163 | 405 | 2,187 |
4| 55 | 163 | 403 | 2,131 |
5| 55 | 163 | 395 | 2,131 |
6| 55 | 157 | 325 | 2,032 |
7| 55 | 157 | 395 | 1,982 |
8| 56 | 157 | 395 | 2,107 |
9| 55 | 157 | 397 | 2,120 |
10| 56 | 157 | 393 | 2,145 |
11| 56 | 157 | 399 | 2,115 |
12| 52 | 157 | 399 | 2,072 |
13| 52 | 155 | 394 | 2,130 |
14| 52 | 155 | 394 | 2,087 |
15| 52 | 155 | 391 | 2,101 |
16| 52 | 153 | 407 | 1,930 |
17| 51 | 155 | 410 | 1,885 |
18| 51 | 153 | 561 | 1,785 |
19| 73 | 234 | 616 | 1,713 |
20| 73 | 234 | 616 | 1,782 |
21| 79 | 231 | 565 | 1,716 |
22| 79 | 231 | 374 | 1,487 |
23| 78 | 223 | 570 | 1,450 |
24| 75 | 226 | 568 | 1,476 |
25| 75 | 226 | 548 | 1,438 |
26| 75 | 226 | 548 | 1,447 |
27| 74 | 226 | 555 | 1,434 |
28| 74 | 226 | 555 | 1,692 |
29| 75 | 226 | 544 | 1,695 |
30| 75 | 224 | 449 | 1,452 |
31| 70 | 224 | 457 | 1,362 |
Aug. 1| 70 | 224 | 457 | 1,588 | 2,876
2| 70 | 224 | 457 | 1,610 |
3| 71 | 224 | 447 | 1,652 |
4| 71 | 224 | 447 | 1,631 |
5| 61 | 224 | 447 | 1,759 |
6| 60 | 224 | 456 | 1,731 |
UNLOADING THE HOSPITAL TRAIN, HELIOPOLIS SIDING.
_To face page 47_]
--------+---------+--------+---------+----------+--------
Date. |Officers.| Nurses.| Rank and| Patients.| No. of
| | | File. | | Beds.
--------+---------+--------+---------+----------+--------
Aug. 7| 60 | 224 | 456 | 1,793 |
8| 60 | 224 | 424 | 1,927 |
9| 59 | 224 | 432 | 1,902 |
10| 58 | 224 | 432 | 339[5]|
11| | | | 357 |
12| | | | 542 |
13| 42 | 216 | 416 | 454 |
14| 47 | 216 | 462 | 504 |
15| 45 | 216 | 462 | 535 |
16| 45 | 216 | 480 | 587 |
17| 47 | 216 | 484 | 485 |
18| 48 | 216 | 460 | 470 |
The proceeding adopted on arrival of the train was as follows: Two
officers were on duty on the platform in control of guard and stretcher
squad. The officer in charge of the train handed in a list of the number
of wounded on the train, classified into lying-down and sitting-up
cases, those of gravity being specially marked. The train was then
emptied carriage by carriage of the sitting-up patients, who walked to
the hospital or were driven by the motor ambulances as the case might
be, tally being kept at the door of the carriage. As soon as the train
had been emptied of the sitting-up cases, the cot patients were removed
by the stretcher squad to the motor ambulances, each of which carried a
load of two patients. In serious cases an officer was sent with the
patient, and as the distance was less than a quarter of a mile, the
transfer was fairly rapid.
The Egyptian ambulance trains were on the whole good, and were equipped
with necessaries and comforts by the Australian Branch British Red
Cross. The Australian military authorities also provided nurses for the
trains. The stretcher squads soon learned and did their work exceedingly
well; but however well the work may be done, the removal of a gravely
injured man from a mattress in a wooden bunk to a stretcher offers some
difficulty and may cause distress. The construction of the wooden bunks
left something to be desired. There is no doubt that it is desirable to
devise a carriage of such a nature that stretchers can be inserted
without difficulty under every patient, and his removal effected without
disturbance.
The patients on arrival in the front hall of the hospital were provided
with hot chocolate and biscuits, or with lime juice, and were at once
drafted to various portions of the hospital. The lighter cases were sent
to the auxiliary hospitals, and the more severe cases transferred to
wards in the Palace building. Four sets of admitting medical officers
with staffs were in readiness, and 200 patients could be disposed of in
an hour. Promptitude was essential, as the trains sometimes followed on
one another quickly. On admission the patients were bathed and given
clean pyjamas. Their clothes and kit were sent to the Thresh Disinfector
to be sterilised before being passed into the pack store.
Every patient on entering the hospital was provided with pyjamas, shirt,
two handkerchiefs, socks, plate, knife, fork, spoon, mug, and slippers.
The Red Cross Society provided him with writing-paper and envelopes,
pencil, chocolate, nail brush, soap, cigarettes, tooth powder, and tooth
brush.
[Illustration: THE LAKE, LUNA PARK, HELIOPOLIS.
_To face page 48_]]
As the equipment of additional beds involved the supply of all these
articles, in addition to mattresses, blankets, linen, towels, kitchens,
cooking-utensils, stoves, bedside tables, ward utensils, instruments,
drugs, and bandages, the strain on the Quartermaster's department during
this period of expansion was very great. The supply and distribution of
food to the auxiliary hospitals occasioned considerable difficulty at
the beginning of the crisis, but was satisfactorily adjusted.
THE AUXILIARY HOSPITALS
As the patients became convalescent they were moved to one of the
auxiliary hospitals, and from the auxiliary hospitals to one of the
convalescent hospitals at Helouan or Alexandria, and thence either
invalided or discharged to duty. As the patients during transference to
the auxiliaries were conveyed in a motor ambulance, and when transferred
to Helouan or Alexandria were motored to Cairo railway station under
charge of a N.C.O., some idea of the work thrown on the motor ambulance
corps and on the staff can be imagined.
So far all the auxiliary hospitals were regarded as wards of the main
hospital, and administered from the main building--the only possible
method of administration at this juncture. It was generally believed
that the Dardanelles campaign would be of short duration, and that Luna
Park and the other auxiliary hospitals would soon be closed.
Consequently the expenditure of much money on these auxiliaries was
deprecated. When, however, it became obvious that the operations at
Gallipoli might last a very long time, and that in any event the troops
pouring into Egypt from Australia and elsewhere would require hospital
accommodation, an entirely new view of the matter was taken, and active
steps were taken to permanently equip the auxiliary hospitals for more
serious work. Of this equipment something must now be said in detail.
At Luna Park the central lake was emptied and drained, and was covered
by an enormous shelter shed provided by the Australian Red Cross. The
shelter with a modern kitchen provided by the authorities formed the
dining-room for the patients, nearly all of whom were able to leave
their beds. In addition an excellent operating-room was built in brick,
barbers' shops were organised, and a canteen, store, and numerous
comforts in the way of blinds, sunshades, punkahs, were provided. Ample
bath and latrine accommodation was added. As time passed, the palm beds
were gradually replaced by metal beds, and the total number reduced to
1,000. In the event of another emergency, beds can be again provided, to
the number of 1,650, but such a step will only be taken in the presence
of necessity.
Furthermore in the case of Luna Park and the other auxiliary hospitals,
the D.M.S. Egypt decided that the feeding of patients should be effected
by contract, and the matter was therefore left in the hands of a
well-known caterer. A large amount of Red Cross money was expended on
the shelter sheds and on a recreation hut managed by the Y.M.C.A., and
Luna Park became an excellent open-air hospital. It is the more
necessary to draw attention to this fact by reason of the adverse
criticisms which have been passed by those who have only a superficial
acquaintance with it. It will be sufficient to say that up to November
1, 5,500 patients had passed through it, and there had been only one
death, and that from anæsthetic. This remarkable result was not
altogether due to the fact that mild cases were admitted, for latterly
many major operations had been performed, for appendectomy, etc., and
according to Colonel Ryan, Consulting Surgeon to the Force in Egypt, all
the operation cases had healed by first intention. In fact Luna Park
really represents the triumph of the open-air method of treating
patients in a rainless country. The patients preferred it because of the
freedom the gardens gave them, but they showed one peculiarity which
could never have been foreseen. The Australian soldier was not very fond
of chairs. He did not want to stay in the shelter sheds, but preferred
to spend much of his day lying in bed, and had to be ordered away from
it to effect any change. It is not unnatural that men who have been
doing excessive physical work should prefer physical rest when they can
get it.
[Illustration: THE SPORTING CLUB, HELIOPOLIS.
_To face page 51_]]
At No. 2 Auxiliary Hospital, the Atelier, similar changes were made. The
Red Cross provided shelter sheds and a number of comforts. The Atelier
was certainly the easiest of the buildings to adapt, by reason of the
relatively small number of patients and its spacious surroundings.
At No. 3 Auxiliary Hospital the building could not accommodate more than
250 patients in any circumstances, but two large tennis courts were
covered with matting and provided with a louvred roof. This proceeding
was followed by the erection of wooden huts each of which constituted a
ward of 50 beds. These huts were placed in convenient relationship to a
central kitchen and other conveniences. The Sporting Club thus became an
excellent outdoor hospital.
The creation of the Infectious Diseases Hospital at Abbassia is another
instance of the importance of prevision. It was organised by Major Brown
(who had already organised Luna Park and the Atelier) as a hospital of
250 beds. By successive squeezes, and by the erection of tents, the
accommodation was rapidly increased to 1,250 beds, and was then
insufficient although typhoid cases were not admitted.
The work of extension was at first difficult, but soon became quite
simple because a considerable number of officers and men became
experienced in the methods of effecting desirable results, and in the
art of adapting means in sight to the end desired.
THE CONVERSION OF THE AUXILIARY HOSPITALS INTO INDEPENDENT COMMANDS
Finally it became obvious that the mechanism was becoming too
complicated, _i.e._ that the administration of all these hospitals from
the Palace Hotel, and the keeping of the records at the Palace Hotel,
had become impossible. It was accordingly decided to separate them and
make them independent commands. This arrangement was completed about the
middle of August, but it involved a fresh crop of difficulties. It was
quite necessary that some one should meet the trains and allot the
patients to the various hospitals. That was a comparatively simple
matter. It was necessary that the hospitals should be properly staffed,
and that those who administered them should receive proper rank, in
other words that there should be a definite establishment. This
necessitated a reference to the Australian Government, and consequently
difficulties and delays.
[Illustration: THE SPORTING CLUB, HELIOPOLIS.
_To face page 52_]]
The valuable and almost essential part played by the Australian Branch
British Red Cross, in effecting the expansion and in preventing a
disaster, will be referred to in the chapter on the Red Cross.
The following table indicates the nature of the increasing demand on the
hospital accommodation:
GROWTH OF THE HOSPITAL (FIRST AUSTRALIAN GENERAL)
_Hospital opened on January 28_
Venereal and
Infectious Cases
Feb. 13 186 cases 358 cases
Feb. 15 200 cases (39 Ophthalmic and
aural cases) 351 "
Feb. 25 324 cases (including 51 special
cases) 422 "
March 1 477 cases, 46 special cases 404 "
March 15 532 " 57 " " 476 "
April 1 596 " 64 " " 283 "
April 15 567 " 52 " " 429 "
April 28 479 " 57 " " 433 "
April 29 631 " 57 " " 478 "
April 30 1,082 " 49 " " 469 "
May 1 1,324 (286 patients discharged) 456 "
May 2 1,465 (213 patients discharged) 462 "
May 3 1,492 453 "
Patients admitted to July 31, 1915 13,325
Deaths 102 = 0·76 per cent.
Largest number of patients admitted on any one day (June 8, 1915):
Australians 408
New Zealanders 85
British 325
Officers 10
-----
828
-----
June 9 219
-----
1,047 in two days.
=====
Sick and wounded received at the First Australian General Hospital at
the end of April:
April 28 195
April 29 469
April 30 529
May 1 354
-----
Total 1,547
-----
Surveying in retrospect this anxious and troublesome period, the
outstanding feature is the mistake made in the constant assumption that
the hospital expansion was temporary. It was stated that Luna Park would
only be wanted for a few weeks; the Dardanelles campaign would soon be
over, Luna Park would not then be wanted, and could be closed,
consequently heavy expenditure on it was deprecated. Furthermore the
experience gained makes it obvious that in war the Service cannot
include too many medical officers--preferably juniors. The demand for
their services here and there is practically unlimited. They should be
young and unattached to any particular unit--in fact a junior reserve on
the spot.
It should be remembered that the expansion of No. 1 Australian General
Hospital was effected under the personal direction of the officer
commanding, Lieut.-Colonel Ramsay Smith, who inspected all new
buildings, gave his approval or disapproval, and was responsible for
their efficient equipment when converted into hospitals.
FOOTNOTES:
[1] Including Luna Park.
[2] 20 Reinforcements.
[3] 38 Reinforcements.
[4] 195 Reinforcements.
[5] Auxiliaries separated and made independent.
CHAPTER V
CONVALESCENT DEPOTS--EVACUATION OF CONVALESCENT SICK AND WOUNDED
FROM CONGESTED HOSPITALS--KEEPING THE HOSPITALS FREE--LIBELS ON
THE EGYPTIAN CLIMATE--DISCIPLINE.
CHAPTER V
It will be remembered that so far as the Australian troops were
concerned, provision had been made for three convalescent hospitals or
homes. The magnificent hotel of Al Hayat at Helouan was taken over on
May 5, emptied of hotel furniture, fitted with palm beds and mattresses,
and converted into a convalescent hospital. As there was no staff in
Egypt available, it was placed under the direction of a military
commandant and a principal medical officer who was a civilian
practitioner resident at Helouan. A few non-commissioned officers and
orderlies were transferred to it from the convalescent camp in the
desert at Zeitoun, which was very properly terminated. The cooking was
effected by arrangement with a professional caterer at a charge of 5_s._
a day for officers, and 3_s._ a day for men. These charges ultimately
included the provision of cooking and eating utensils. This convalescent
hospital both in its general character and with respect to the food
supplied represents in all probability the most successful effort made
in Egypt. In fact it has been suggested that the hospital was almost too
attractive, and that there was consequently a good deal of
disinclination to leave it. In favour of the principle involved in
installing a military commandant to administer a convalescent hospital
there is much to be said, as the administration is one man's work.
MONTHLY MEANS, WET BULB TEMPERATURE
----------+-----+-----+-------+-------+-----+------
| Jan.| Feb.| March.| April.| May.| June.
----------+-----+-----+-------+-------+-----+------
Alexandria| 53·4| 54 | 56·5 | 60 | 64·2| 71·2
Heliopolis| 51·8| 52·7| 57 | 59·7 | 64·9| 72·3
Helouan | 50 | 50 | 53·8 | 57·4 | 61 | 67·3
----------+-----+-----+-------+-------+-----+------
----------+------+--------+------+-----+-----+-----
| July.| August.| Sept.| Oct.| Nov.| Dec.
----------+------+--------+------+-----+-----+-----
Alexandria| 73·4 | 73·8 | 69 | 66 | 61·2| 56·9
Heliopolis| 73 | 74 | 70·2 | 65·7| 60·1| 54·7
Helouan | 68·9 | 69·2 | 68·2 | 62·4| 57·6| 52·7
----------+------+--------+------+-----+-----+-----
Maximum at Helouan, 77·3. Minimum at Helouan, 36·7.
THE EGYPTIAN CLIMATE
Those who know Helouan and the hotel will not be surprised at the
success of the Hospital, but it may surprise even those who know Egypt
to learn that Helouan is considerably cooler than Cairo, notwithstanding
the fact that it is situated on the edge of the desert. Owing to dryness
the Wet Bulb temperature is considerably lower than at Cairo in
midsummer and the nights are always cool.
It must be remembered that the figures in the attached table give means
only, and that any registration over 75°F. Wet Bulb is high, and that at
80°F. Wet Bulb work becomes difficult. At 90°F. Wet Bulb the danger
point is reached, and all work must cease on pain of death from heat
apoplexy.
It will be seen, then, that Egypt is not especially hot, even from May
till October, and that Helouan is particularly cool. These conclusions
coincide with the feelings of those who live there. Alexandria is
pleasant by day, because of the sea breezes, but at night most people
prefer Heliopolis, which is drier and where they are more likely to
enjoy a breeze.
[Illustration: ENVIRONS OF CAIRO
The Red Cross indicates Medical Stations of special interest to the
Australian Force.
_To face page 58_]]
[Illustration: HELIOPOLIS PALACE HOTEL: CONVALESCENTS ON THE PIAZZA.
_To face page 59_]]
These observations apply to the weather after May. From March to May the
khamsin may blow for several days. The temperature then is high, but the
air very dry. Khamsins usually cease in May.
CONVALESCENT HOSPITALS
The Ras el Tin Convalescent Hospital at Alexandria was organised on
similar principles to those adopted at Al Hayat, for those who required
seaside change and sea bathing. At a later period half the accommodation
in the Montazah Convalescent Hospital was rendered available to
Australians. The Montazah Hospital will be described under the heading
of Red Cross.
By the use of these three convalescent hospitals, accommodation was
provided for 1,500 patients, but in case of necessity at least another
800 could have been accommodated. In addition a large convalescent camp
was erected at Zeitoun in case of emergency. After the engagement in
August, a very great rush of wounded was expected, and had the hospitals
and convalescent homes been really taxed the convalescent camp would
have been utilised for overflow purposes. Fortunately this did not
become necessary, but the experience of May had given sufficient warning
of possibilities.
The normal progress, then, of a patient admitted to No. 1 General
Hospital suffering from a serious wound or a serious disease of
non-infectious character was removal to one of the auxiliary hospitals
when he reached the semi-convalescent stage, and removal to one of the
convalescent hospitals when he reached the convalescent stage. From
these hospitals he was discharged to duty.
Now, Helouan is twenty miles from Cairo, and can be reached by railway
or motor ambulance; and the railway station in Cairo for Helouan is
eight miles from Heliopolis. As the patients were moved from Heliopolis
to Helouan in scores or even hundreds at a time, some idea of the tax
imposed on the motor ambulance corps can be imagined. During the crisis
of May, June, and July, a visitor could witness an eternal procession of
trains discharging wounded at Heliopolis, of trains discharging wounded
at Cairo for other hospitals, of sick being moved to and from the
different hospitals in Cairo, and convalescents from the various
hospitals being sent to the Cairo station for Alexandria or to the Bab
el Louk station for Helouan. Without an adequate supply of motor
ambulances such an organisation would have been impossible.
It should be understood that the convalescent hospitals were available
not only to all Australian sick and wounded from any hospital, but also
to British or New Zealand sick and wounded. The adjustment of accounts
between the separate Governments was a matter of discussion, and it was
finally agreed that in the case of hospitals no charges should be made
by reason of the section of the force to which the sick or wounded man
belonged. It was desirable as far as practicable to send the Australians
to Australian hospitals, but if the treatment of the sick and wounded
necessitated it, no hard-and-fast distinction was to be observed. In the
case, however, of convalescent hospitals, in which the matter could be
dealt with in a more leisurely way, the respective Governments were
charged the cost of maintenance of soldiers belonging to them.
ARMY MEDICAL ADMINISTRATION
When the _Kyarra_ arrived in Egypt the military medical arrangements in
that country were on a very small scale, and under the administration of
the D.M.S. they rapidly enlarged. But the unexpected rush on April 29
found the British Medical Force to a considerable extent, and justly,
dependent on the Australian Force for hospitals, medical officers,
nurses, transport, specialists, and Red Cross stores. As there is really
only one service and one object in view, it is quite unnecessary to
emphasise the satisfaction felt by Australians in being of substantial
service at a critical time. Since then the development of the medical
services has steadily proceeded, and the anxiety of May, June, and July
is never likely to be experienced again.
DISCIPLINE
A word must be said on the subject of discipline and its influence on
Australians. The bravery and resourcefulness of Australians in the field
are sufficiently attested by those competent to judge. Of their splendid
behaviour when desperately injured we have had ample evidence, which we
furnish with proper respect to brave men.
The convalescent Australian presents another problem, as also does the
soldier waiting at the base. The lines in Dr. Watts's hymn come to
mind. In these circumstances his very fine qualities cause him to give
trouble. His ingenuity in breaking bounds is worthy of a better cause.
For example, there were complaints from the military police that sick
men were roaming about Cairo at night. The roll was called at No. 1
General Hospital several times, and no one was absent. Not quite
satisfied, we called the roll in the Ophthalmic Ward one evening at 8
p.m. Only one man was absent. Still suspicious, we called it again at
8.40 p.m. the same evening, and twenty-one men had gone. Some had rolled
up coats or blankets and so placed them that it seemed that the men were
still in bed. Subsequently uniforms that should have been in the pack
store were discovered under their mattresses.
These and similar difficulties were aggravated by the fact that even a
moderate disciplinarian did not always receive the support of the nurses
or even the medical officers.
To illustrate: An endeavour was made to limit smoking in the wards to
reasonable hours, as it has become an unfortunate tradition that a sick
soldier may smoke cigarettes all day long, when in bed, without injury.
One of us (J. W. B.) entered a small ward which was filled with smoke,
and was just in time to see a sick man practically blowing smoke into a
nurse's face; needless to say the cigarette vanished with astonishing
rapidity. Looking through the murky atmosphere, I asked the nurse
whether she had seen any one smoking, to which she unblushingly replied,
"No, sir."
If nurses and a section of officers throw their weight against
enforcement of discipline, because they don't think it necessary or
right, the difficulties become considerable.
Again, the sentries were often in collusion with the men. Two instances
suffice: A soldier got out of the hospital through a hole in the fence.
On returning he determined to test the sentry with an eye to future
escapades. Walking up to the gate, he said, "I want to visit a friend."
"Have you got a pass?" said the sentry. "No," replied the sick man. A
discussion followed, and finally the sentry said, "Go in and out by the
hole in the fence; it will save me a lot of trouble."
Yet another amusing incident. Sitting on the great Piazza at Heliopolis
were a number of men convalescent from serious illness, pneumonia and
the like.
A short distance away on the outside of the iron railing fence, the
Arabs were conducting illicit and prohibited trade with the men inside,
and a sentry appointed to prevent it was walking up and down studying
astronomy.
The Commanding Officer witnessed the occurrence, visited the happy
scene, interrogated the sentry, and asked him what his duties were. The
sentry answered, "To walk up and down here with me gun to prevent them
prisoners" (the unfortunate convalescents) "coming down them steps, and
to prevent them niggers jumping the fence!"
The hardest part of military work is waiting. The soldier who has the
magnificent fundamental qualities of the Australian, and who can wait
and obey, would be the greatest soldier on earth. We are hopeful that
the experience gained will render the Australian the claimant for this
coveted position. All thoughtful Australian officers we know tell the
same story: "Give us discipline, and again and again discipline."
There is much to be said for the soldier. He will obey if he knows why
an order is given, or if he trusts his officer and knows why it is
given. But if he is uncertain on these points he pleases himself.
Discipline cannot be enforced in general, except by properly trained
professional officers.
Again, there was more drunkenness than there should have been from the
same cause. One evening visitors passed liquor into hospital, and a
hideous din arose. On seeking the cause, I discovered it to proceed from
a ward containing three patients, of whom one had a broken leg and
another a broken arm.
These two men were uproariously drunk, and were sitting up in bed making
Australian political speeches. On my entry he of the broken leg demanded
in broken tones to be at once paraded before the orderly officer.
On another occasion a particularly nuggety patient had broken the rules,
and becoming troublesome was ordered back to his ward. Refusing to go,
the guard was sent for, and a fight of a desperate character ensued
before he was overpowered; yet we found accidentally that later on this
man was made a N.C.O. and apparently gave satisfaction.
In other armies such an offence might have been punished with death.
On reading the account of the life of Stonewall Jackson it is clear that
similar difficulties were experienced with the Confederate soldiers, and
that Jackson against his inclination was compelled to enforce grave
penalties at times to prevent still graver trouble.
It takes several men on the lines of communication and at the base to
keep one man at the front, and only loyal obedience to orders during the
wearisome and exacting day's work on the lines of communication will
make the machine run smoothly, and do justice to the man in the line of
battle who is risking his life.
Yet it seems to us there is much to be done by attention to the
soldiers' social wants. The work of the Y.M.C.A. and the provision of
soldiers' clubs were powerful influences in favour of good order and
conduct.
CHAPTER VI
EVACUATION OF THE UNFIT--RELIEVING THE PRESSURE ON THE HOSPITALS
AND CONVALESCENT DEPOTS--BACK TO DUTY OR AUSTRALIA--METHODS
ADOPTED--TRANSPORT OF INVALIDS BY SEA AND TRAIN.
CHAPTER VI
It became evident, both during the crisis and before the expected attack
in August, that Egypt must be cleared of those who were not likely to be
fit for service in the immediate future. The necessary effort made to
send invalids away for change, and to send the permanently disabled
home, involved important questions of policy the determination of which
took time. A number of problems at once obtruded themselves. Who was to
be permanently invalided, and how was the determination to be reached?
Who was to be sent away temporarily, and for how long was he to go?
Where was he to be sent to? What was to be done with malingerers, of
whom there was a small but sufficiently numerous percentage? As regards
the first question: is a man, for example, who has lost an eye
permanently invalided? Is he fit for base duty in Egypt, or must he be
sent home? It is hardly fair to send him to the front and expose him to
the risk of total blindness. In this particular case, in view of the
possibilities of the development of ophthalmia in Egypt--which, by the
way, did not prove nearly as serious as was anticipated--it was decided
that the man who had lost one eye should be sent home as permanently
unfit. Men who had lost a limb were put in the same category. It might
be argued that such men were quite fit for clerical work, and that
one-eyed men were quite fit for ordinary guard work, for which, indeed,
the demand was overwhelming. The view already indicated, however, was
taken, and these men were sent to their homes to be discharged. But when
these definite and obvious cases were disposed of, there remained some
thousands of men whose cases were full of difficulty. In each hospital
Boards were accordingly appointed to investigate their cases and to
fully answer the questions set out in the following Army Form B 179.
MEDICAL REPORT ON AN INVALID
(Taken from Army Form B 179)
8. DISABILITY
STATEMENT OF CASE
NOTE.--_The answers to the following questions are to be filled
in by the officer in medical charge of the case. In answering
them he will carefully discriminate between the man's
unsupported statements and evidence recorded in his military
and medical documents. He will also carefully distinguish cases
entirely due to venereal disease._
9. Date of origin of disability.
10. Place of origin of disability.
11. Give concisely the essential facts of the history of the
disability, noting entries on the Medical History Sheet bearing
on the case.
12. (_a_) Give your opinion as to the causation of the
disability.
(_b_) If you consider it to have been caused by active service,
climate, or ordinary military service, explain the specific
conditions to which you attribute it. (_See_ NOTES _on p._
71.)
13. What is his present condition?
_Weight should be given in all cases when it is likely to
afford evidence of the progress of the disability._
14. If the disability is an injury, was it caused--
(_a_) In action?
(_b_) On field service?
(_c_) On duty?
(_d_) Off duty?
15. Was a Court of Inquiry held on the injury?
If so--(_a_) When?
(_b_) Where?
(_c_) Opinion?
16. Was an operation performed? If so, what?
17. If not, was an operation advised and declined?
18. _In case of loss or decay of teeth._ Is the loss of teeth
the result of wounds, injury, or disease, directly[6]
attributable to active service?
19. Do you recommend--
(_a_) Discharge as permanently unfit, or
(_b_) Change to England?
--------------------------------
_Officer in medical charge of case._
I have satisfied myself of the general accuracy of this report,
and concur therewith, _except_[7]
_Station_----------------
_Officer in charge of Hospital._
_Date_----------------
OPINION OF THE MEDICAL BOARD
NOTES.--(_i_) Clear and decisive answers to the following
questions are to be carefully filled in by the
Board, as, in the event of the man being invalided, it is
essential that the Commissioners of Chelsea Hospital should be
in possession of the most reliable information to ENABLE THEM
TO DECIDE UPON THE MAN'S CLAIM TO PENSION.
(ii) Expressions such as "may," "might," "probably," etc.,
should be avoided.
(iii) The rates of pension vary directly according to whether
the disability is attributed to (_a_) active service, (_b_)
climate, or (_c_) ordinary military service. It is therefore
essential when assigning the cause of the disability to
differentiate between them (_see_ Articles 1162 and 1165, Pay
Warrant, 1913).
(iv) In answering question 20 the Board should be careful to
discriminate between disease resulting from military conditions
and disease to which the soldier would have been equally liable
in civil life.
(v) A disability is to be regarded as due to climate when it is
caused by military service abroad in climates where there is a
special liability to contract the disease.
20. (_a_) State whether the disability is the result of (i)
active service, (ii) climate, or (iii) ordinary military
service.
(_b_) If due to one of these causes, to what specific
conditions do the Board attribute it?
21. Has the disability been aggravated by--
(_a_) Intemperance?
(_b_) Misconduct?
22. Is the disability permanent?
23. If not permanent, what is its probable minimum duration?
_To be stated in months._
24. To what extent is his capacity for earning a full
livelihood in the general labour market lessened at present?
_In defining the extent of his inability to earn a livelihood,
estimate it at ¼, ½, ¾, or total incapacity._
25. If an operation was advised and declined, was the refusal
unreasonable?
26. Do the Board recommend--
(_a_) Discharge as permanently unfit, or
(_b_) Change to England?
Signatures:--
------------
_President_.
------------
_Members_.
_Station_ ------------
_Date_ ------------
APPROVED.
_Station_ ------------
------------
_Administrative Medical Officer_.
_Date_ ------------
It should be remembered that the bulk of the medical officers were
civilians, that they were unaware of the broad questions of policy
involved, and that they were inclined on principle to give a holiday to
a man who had been fighting, and even to believe the stories told them
by the malingerer. The reader will therefore not be surprised to learn
that a number of men who were certainly not in a very bad way were
recommended for two, three, or six months' change, or even for
discharge. The proceedings of the Board were reviewed by a responsible
officer; for a long time by Lieut.-Col. Barrett when acting as A.D.M.S.
on General Ford's staff. It was, however, difficult to persuade any
Board which had once expressed their opinion to modify it, and almost
impossible to get them to reverse it. If their recommendations had been
rejected altogether, the conduct of the Service would have become
difficult. Under direction, an attempt was made to modify the practice
by appointing a permanent Board in each hospital, presided over by a
senior medical officer charged with the duty primarily of attending to
Board work, and of acting as a clinician only when he had time.
THE FOLLOWING DRAFT WAS MADE THE BASIS OF THE ARRANGEMENT
1. Two medical officers are to be detached from other duties at Nos. 1
and 2 Australian General Hospitals respectively, in order to form a
majority of a permanent invaliding board at each hospital. They will be
known as the senior and junior invaliding officer respectively.
2. The duties of the Board at Nos. 1 and 2 Australian General Hospitals
will be to form an Invaliding Board by meeting in each case the medical
officer in charge of the case.
3. The Board proceedings when completed will be sent to the A.D.M.S.
Australian Force, Headquarters, Cairo, and on being approved will at
once be forwarded with nominal roll to the Australian Intermediate Base
Depot, Cairo.
4. The Australian Intermediate Base will forward to the O.C. Hospital or
Convalescent Home nominal roll of patients who are to be discharged or
transferred to Australia or England. These patients will be transferred
to the Convalescent Home, Helouan (if they are able to leave hospital),
and will remain at the Home till transport is ready for them.
5. The only circumstances in which completed Board cases are to be
retained in any hospital, except the Convalescent Home, Helouan, are
when patients require a considerable amount of treatment, and are unfit
to leave the hospital.
6. The senior invaliding officer will be responsible for the accuracy of
the nominal rolls.
7. At Alexandria an invaliding officer will be attached to the
Australian Convalescent Home at Ras el Tin. It will be his duty, under
direction of the A.D.M.S. Alexandria, to proceed to the various
hospitals and camps in Alexandria, arrange for the formation of Boards,
of which he will be a member, to deal with all cases in Alexandria.
These cases, in like manner, must be forwarded to Convalescent Home,
Helouan, except in the cases of those who are unfit to leave hospital.
8. The cases to be dealt with fall into two classes: (_a_) men unfit for
military service, who may be sent by (i) transport to Australia or (ii)
by hospital ship to Australia; and (_b_) men likely to profit by change
to England during hot weather, to proceed by (i) transport or (ii)
hospital ship.
9. The Board proceedings are to indicate, in the opinion of the Board,
the best manner of dealing with patients under the several headings.
_June 30, 1915._
Again difficulties arose, since none of the medical officers wanted the
job. In fact, medical officers in general never want to do anything
except attend to patients. They are unsuited temperamentally for
administrative work, and dislike it. Even with this modification, though
the system worked somewhat better, evils obtruded themselves. The
statements of men who swore they were suffering from rheumatism and
severe pains in the back were sometimes taken at face value, and further
modification consequently became necessary. Any medical officer could
recommend any patient to be boarded. The Board then sat and sent in its
report to the A.D.M.S. Under the modified arrangement no patient could
be boarded until he had been examined by the senior medical officer of
the Australian Force in Egypt, or by the D.D.M.S. Egypt, Col. Manifold.
By this means most of the trouble was eliminated and a satisfactory
principle was established. It is the old story--the reversion to
direction by a limited number of experienced and responsible people.
It was decided not to send Australian patients to Great Britain other
than in exceptional cases, that is if they had friends or relatives
there, and if they only required a short change, say two months. As the
voyage to Australia occupied a month each way, it was absurd to send
them back there for two months. For three months or more they were sent
to Australia, and in some cases were discharged on arrival. Some men who
were no longer fit for service at the front were kept in Egypt for Base
Duty.
Only those who have experience of base work become aware of the enormous
demands made on a garrison for guard work, for clerical work, orderly
work, and the like. At Al Hayat, Helouan, for example, the commandant
really required ninety men for sentry work, though he had only forty.
The demands for competent clerks were incessant.
[Illustration: THE EASTERN MEDITERRANEAN.
The Red Cross indicates Medical Stations of special interest to the
Australian Force.
_To face page 77_]]
As soon as patients were destined for dispatch to Australia they were
forwarded to Helouan and kept there until the ship was ready to leave.
As a result Helouan was filled with waiting cases. In order then to ease
the pressure at Helouan, a waiting camp was established at Suez close to
the Government Hospital, to which any patients could be admitted. This
establishment of course necessitated further demands for medical
officers, orderlies, etc.
TRANSPORT OF SICK AND WOUNDED BY SEA
As soon as it was decided to return patients to Australia in addition to
those sent to England, Cyprus, or convalescent hospitals in Egypt, a
system was developed in order to provide the necessary staffs and
equipment on ships. Surgeon-General Williams had exerted himself to get
hospital ships provided, but in the early stages they had not even been
promised, and a service was perforce created by utilising empty
transports and collecting the staff in Egypt. The first efforts may be
described as almost maddening. It was impossible to get adequate notice
when a ship was likely to leave for Australia. It had probably been to
the Dardanelles and unloaded soldiers and munitions of war. It had
returned to Alexandria packed with wounded. It might then be drafted to
Australia, at a few days' notice. It was necessary to clean and refit
it, to place hammocks, blankets, beds on board, to provide drugs and
surgical appliances and Red Cross stores, and to provide a staff in
Egypt.
In looking back on the efforts made, the wonder is not that minor
defects occurred in the early stages, but that the work was done
anything like as well as it was. The difficulties were almost
insuperable, and nothing but the devotion of a number of medical
officers to the service rendered any decent result possible.
The first ship to leave with wounded on board was the _Kyarra_ on June
7, but previously a number of ships had left containing invalids,
venereal cases, undesirables, and oddments. In every case there was a
scramble at the last moment to get things ready. The staff for the ships
was provided by detailing officers, nurses, and orderlies from the
scanty staffs of Nos. 1 and 2 General Hospitals. The Australian
Government, under request, then began to provide transport staffs who
came with the troopships and returned at later intervals when the
troopships went back again as "hospital carriers." Of hospital ships
proper there were none. Each ship was inspected in order to ascertain
the number of patients she could carry, and to determine the staff
requisite--consequently a routine procedure was adopted. Cot cases were
seldom taken, as it was thought better where possible to keep cot cases
in Egypt. A minimum of two medical officers was allowed for 300
patients, and an additional medical officer for every 150 patients. One
trained nurse was allowed for every 50 patients, and one orderly for
every 25 patients. These numbers were arbitrary and approximate, but
served as a working basis. The supply was probably in excess of real
requirements, but it was necessary to contemplate the possibility of an
epidemic outbreak in the tropics and the grave results which might
ensue. The equipment of drugs and instruments was liberal, and was
arranged on a fixed plan worked out by the officer in charge of the
base medical store at Heliopolis. The Red Cross stores were supplied in
the same way, and the commanding officer was given a sum of money,
sometimes as much as £150 to £200, to spend on comforts for the men. A
canteen was placed on board in addition. The ship was not allowed to
leave the wharf until the commander had given a certificate that he had
on board all the medical comforts required by the Admiralty regulations,
and until the principal medical officer had given a certificate that he
had all that he required in the way of staff, drugs, surgical and
medical equipment, and Red Cross stores.
There is no more dangerous branch of medical service than the transport
of sick and wounded over the ocean, since there are so many
possibilities of disaster.
BASE MEDICAL STORE
These continual demands on personnel and on medical stores necessitated
suitable arrangements, and messages were sent to Australia asking for
reinforcements. In addition a large base medical store was established
at Heliopolis, and made an independent unit. It became the business of
the officer in charge of this store, Captain Johnson, to make up drugs
and surgical instruments per 100 patients, and to receive the surplus
stores from each of the incoming transports. Two hospital ships were
ultimately provided, the _Karoola_ and the _Kanowna_, and reached Egypt
in October.
CASES RETURNED TO AUSTRALIA FROM FEB. 3 TO SEPT. 25, 1915, AND REASONS
Officers = O. Other ranks = O. R.
----------+----------+----------+---------+----------+-----------+----------
Medically| Venereal | Services | Other | Change | | Wounded
Unfit. | Cases. | no longer| reasons.| to | Total. | in
| | required.| |Australia.| | Action.
---+------+---+------+----+-----+---+-----+---+------+----+------+---+------
O.| O.R. | O.| O.R. | O. |O.R. | O.| O.R.| O.| O.R. | O. | O.R. | O.| O.R.
---+------+---+------+----+-----+---+-----+---+------+----+------+---+------
29| 2,496| | 1,344| 5 | 215| 24| 49| 29| 1,154| 137| 5,258| 52| 1,571
| | | | | | | | | | | | |
| | 450 also | | | | | | | | | |
| | sent to | | | | | | | | | |
| | Malta | | | | | | | | | |
---+------+----------+----+-----+---+-----+---+------+----+------+---+------
TRANSPORT OF SICK AND WOUNDED TO SUEZ
The arrangements for conveying the invalids from Cairo to Suez were
interesting. They could not be conveyed to Alexandria or Port Said
because one passenger placed on a ship at those ports enormously
increased the charges made by the Suez Canal Company, and Suez was
consequently fixed upon as the port of departure and the port of
equipment. Patients to be conveyed to Suez were at Helouan, or at
different hospitals in Cairo, and accordingly two trains were made
up--one at Helouan and one at Palais de Koubbeh, Heliopolis. Each train
was filled at a specific time, the two trains conveyed to Cairo, a
junction effected in the Cairo station, and the whole conveyed to Suez.
The journey took about five hours, and the necessary provision was made
for feeding the men on the way. One of the difficulties in conveying
such patients was to prevent them riding on the platforms of the
carriages and falling off. A sentry was placed at each end of the
carriage to prevent the continuance of these disasters, which had been
too numerous in the case of healthy men in the troop trains. Men had
even lost their lives or been mutilated from trying to ride on the
buffers _à la Blondin_.
[Illustration: The Red Cross indicates Medical Stations of special
interest to the Australian Force.
_To face page 80_]]
On arrival at Suez the train proceeded alongside the ship, the patients
and their kit were moved on board, and a guard placed in the dockyard.
Even then men straggled into Suez, and their recapture gave some
trouble. The Australian is essentially a roamer.
The table on page 80 indicates the number of soldiers returned to
Australia up to September 25, 1915, and the reason for their transfer.
FOOTNOTES:
[6] Loss of teeth on, or immediately after, active service, should be
attributed thereto, unless there is evidence that it is due to some
other cause.
[7] Delete this word if no exceptions are to be made.
CHAPTER VII
SICKNESS AND MORTALITY AMONGST AUSTRALIANS--THE DANGERS OF CAMP
LIFE--STEPS TAKEN TO PREVENT EPIDEMICS--NATURE OF DISEASES
CONTRACTED AND DEATHS RESULTING--DEFECTIVE EXAMINATION OF
RECRUITS--OPHTHALMIC AND AURAL WORK--THE FLY PEST--LOW
MORTALITY--THE EGYPTIAN CLIMATE AGAIN--SURGICAL WORK AND
SEPSIS--CHOLERA--INFECTIOUS DISEASES.
CHAPTER VII
In civil practice we had long been aware of the fundamental failing of
the medical profession. Its members operate in a community as
individuals. They seek to cure disease in general; they are
conscientious to a degree in the discharge of this duty, and they give
valuable personal advice respecting hygiene. But of the prophylaxis of
disease they have little trained knowledge, and they are not seriously
interested. The prophylaxis of disease really implies organised and
co-operative effort, and can only be effectively undertaken by those
public-health officials who are charged with it as a definite function.
In Australia at all events the inducements to enter the public-health
service as a profession are not very great. The influence of the
department is not very far-reaching, and the prophylaxis of disease is
still in its infancy. One can foresee the time when the number of
practitioners per 100,000 of the population will be fewer than at
present, and the number of public-health officials will be greater. The
transition from the one occupation to the other will only take place
when a much higher standard of general intelligence prevails in the
community.
What applies to civil life applies to a lesser extent to an army,
because the headquarters staff of an army are as a rule excellently
informed respecting the risk run by neglect of sanitation. They
understand thoroughly that disease may do more harm than battles, and
that outbreaks permitted to get out of hand are with difficulty
controlled. In the Australian Army, by reason of its necessarily scratch
nature, there was practically no instruction in prophylaxis. It was
certainly not acutely understood, and the disastrous events which
attended the formation of camps in Victoria and elsewhere show that the
controlling authorities were either not fully informed of the risks, or
if informed, did not understand the best plan of action. What applied in
Australia was true to a lesser extent in Egypt, because Surgeon-General
Williams and many of the R.A.M.C. officers who controlled medical
operations in Egypt, and distinguished members of the Indian Medical
Service who were associated with them, had been through a number of
campaigns in South Africa and elsewhere, and were aware both of the
risks and the difficulties. Consequently some effort was made to avoid,
or to minimise the effects of, some of the disastrous outbreaks.
In March and April, before the arrival of wounded, the number of cases
in hospital was a source of common comment amongst the medical officers,
who could not understand why healthy men under service conditions,
camped on the edge of a dry desert, should be suffering from serious
disease to such an extent. The diseases were for the most part measles,
with its complications, bronchitis, broncho-pneumonia, and a certain
amount of lobar pneumonia, infectious pleuro-pneumonia, and tonsillitis.
There were a few cases of cerebro-spinal meningitis. The impression made
on a physician who had all the cases coming from the Heliopolis camps
under his control was that these diseases were inordinately prevalent;
but the following figures, obtained from headquarters and forwarded to
the Government, show that while disease was more extensive than it
should be, it was not excessive. Including venereal disease, the cases
certainly did not exceed 6 to 8 per cent. of the force.
[ILLUSTRATION: OFFICERS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL.
_To face page 86_]]
FIRST AUSTRALIAN GENERAL HOSPITAL
_Memorandum prepared to show the Extent of Disease amongst Australian
Troops_
PALACE HOTEL,
HELIOPOLIS,
_May 8, 1915_.
(Report begins) "The following figures have been obtained from the
office of the D.M.S. Egypt. Owing to the movement of troops out of
Egypt, comparisons are apt to be a little difficult to institute with
accuracy. Nevertheless the figures given substantially indicate the
position.
On February 15 there were 1,329 patients in hospital. The number of sick
and off duty in the lines, but not in hospital, is not stated; but as it
amounted to 423 on February 1, and to 644 on March 1, it may be assumed
to be 500, which will give a total of 1,829 sick and off duty on
February 15.
On March 1, 1,737 men were in hospital, 644 off duty and sick in the
lines, or a total of 2,361.
On March 15, 1,429 were in hospital, 500 off duty and sick in the lines,
or a total of 1,929.
On April 1, 1,217 were in hospital, 495 sick and off duty in the lines,
or a total of 1,712.
The totals, therefore, off duty on the dates specified were:
February 15 (approx.) 1,829
March 1 2,381
March 15 (approx.) 1,929
April 1 1,712
It should be stated that the figures quoted above would have been very
much larger were it not that a large number of men unfit for duty by
reason of venereal and other forms of disease have been returned to
Australia, and a considerable number sent to Malta.
There have been returned to Australia by the _Kyarra_ on February 2, the
_Moloia_ on March 15, the _Suevic_ on April 28, and the _Ceramic_ on May
4, a total of 337 soldiers who were medically unfit for various reasons,
and 341 suffering from venereal disease, or 678 in all. In addition
about 450 were sent to Malta. If these soldiers had been added to the
list of those reported sick and unfit for duty daily, the number would
have considerably exceeded 2,000. The estimate of 2,000 sick and unfit
for duty daily was studiously moderate, as pointed out in a private
letter to Colonel Fetherston at the time when precise figures could not
be immediately obtained.
It is gratifying to find that the amount of sickness is diminishing and
that the amount of venereal disease, so far as can be ascertained, is
also decreasing.
Strenuous efforts have been made by the A.M.C. to attack both forms of
inefficiency by dealing with the causes, and with a view to avoiding
future troubles the D.M.S. Egypt has appointed a committee of medical
officers to inquire into the causations of the outbreak. It is unlikely
that the committee can be very active just at present, because of the
prior claims on the time of all concerned owing to the influx of
wounded. At a later period it is hoped that an exhaustive report will be
furnished for the benefit of future undertakings.
Most strenuous efforts have been made to limit the amount of venereal
disease. General Birdwood, Commander-in-Chief of the New Zealand and
Australian Army Corps, has personally interested himself in this
question, and has through the O.C. First Australian General Hospital
arranged for me to visit each troopship on arrival, all leave being
stopped from the transport until I have been on board. The practice
followed is to interview the commanding officer and the officers of the
transports, to explain to them the gravity of the position, and to ask
each and all of them to use all the influence he possesses with his men
to deter them from exposing themselves to the risk of contagion, to draw
their attention to the fact that on the physical fitness of the
individual man depends the possibilities of success to the army, and to
ask for the loyal and enthusiastic co-operation of every officer in work
of such importance from a military point of view, and the point of view
of subsequent civil life. The officers immediately parade the men,
address them, and convey to each of them a printed message from General
Birdwood. General Birdwood's letter to General Bridges, written during
the early part of the stay of the Army in Egypt, is handed to the
Commanding Officer to be read by him and his staff. There is no doubt
that this systematic procedure has drawn attention to the gravity of
the problem. It has always been responded to loyally by the officers
concerned, and it has certainly limited the action of young and
inexperienced men on their first landing in an Eastern country.
Other steps were taken by Surgeon-General Williams, who on arrival in
Egypt called a conference of senior medical officers to consider the
gravity of the venereal diseases problem.
It is satisfactory to find, notwithstanding the amount of disease which
has existed, and which, while not excessive, is still heavy, that the
mortality has not been as serious as it might have been. The mortality
in No. 1 Australian General Hospital for February and March was
seventeen cases out of a total of 3,150 admitted" (Report ends).
The following return shows the total number of casualties in the
Australian Force up to July 16, 1915:
---------------+----------+-------------+-------
Casualty. | Officers.| Other Ranks.| Total.
---------------+----------+-------------+-------
Killed | 110 | 1,598 | 1,708
Died of Wounds | 46 | 740 | 786
Wounded | 341 | 8,404 | 8,745
Missing | 16 | 770 | 786
Died of Disease| -- | 43 | 43
---------------+----------+-------------+-------
Totals | 513 | 11,555 | 12,068
---------------+----------+-------------+-------
The next table shows the average length of stay in hospital of venereal
cases at a particular date:
FIRST AUSTRALIAN GENERAL HOSPITAL
Total venereal cases admitted 1,288
Average stay of patients 16 days
THE ENLISTMENT OF THE UNFIT AND ITS CONSEQUENCES
Prior to the arrival of the wounded the medical service was
inconvenienced by another circumstance. Men were continually arriving
with hernia, varix, and other ailments which they had suffered from
before enlistment, and which had been overlooked during the preliminary
examination in Australia. In one case a soldier suffering from aortic
aneurism arrived in Egypt, and similar instances might be given. The
examination of recruits in Australia had been conducted by practitioners
in country towns and elsewhere, often under conditions highly unfair to
the practitioner. There is no doubt that the Government would have been
well advised to have withdrawn a few men from private practice
altogether, paid them adequate salaries, and made them permanent
examiners of recruits. Experience of war demonstrates most completely
the folly of sending any one to the front who is not physically fit. It
is apt to be forgotten that in warfare there can be no holidays, or days
off, and that the human being must be at his maximum of physical
efficiency, and his digestion of the best. If his soundness is doubtful
it is better to keep him for base duty at home, on guard duty at the
base, or as an orderly in the hospital. It is simply a waste of money,
and tends to the disorganisation of the service, to send such people
anywhere near the fighting line. We made an attempt at one stage to
roughly calculate what the Australian Government had lost in money by
the looseness of official examination. It was impossible to make an
accurate estimate, but the sum was great.
OPHTHALMIC AND AURAL WORK
When one of us joined the hospital as oculist and aurist and registrar
(Lieut.-Col. Barrett) he was informed that specialists were not
required, but apparently those responsible had formed no conception of
the excessive demands which would be made on the ophthalmic and aural
departments. The first patient admitted to No. 1 General Hospital was an
eye case, and an enormous clinic rapidly made its appearance. It was
conducted somewhat differently from an ordinary ophthalmic and aural
clinic, in that (by reason of the remoteness of their camps) some
patients were admitted for ailments which would have been treated in the
out-patient department of a civil hospital. There were usually from 60
to 100 in-patients and there was an out-patient clinic which rose
sometimes to nearly 100 a day. It should be remembered that these
included few, if any, serious chronic cases, which were at once referred
back to Australia. The amount of ophthalmic and aural disease was very
great. The figures subjoined show the extent of the work done.
From the opening of the Hospital to September 30, 1915, the patients
treated in the Ophthalmic and Aural Department numbered as follows:
Ophthalmic cases 1,142
Aural, nasal, and throat cases 1,474
There were 246 operations.
The ophthalmic cases may be roughly classified as follows:
Ophthalmia (chiefly Koch-Weeks and a percentage
of Diplo-Bacillary) 546
Affection of lids 15
Pterygium 8
Corneal opacities 6
Trachoma 17
Iritis 12
Cataract 8
Foreign bodies in the eye 14
Old injuries 9
Detachment of retina 2
Strabismus 16
Concussion blindness 4
Refraction cases:
(a) Hypertropia 210
(b) Myopia 30
(c) Hypertropic astigmatism 230
(d) Myopic astigmatism 15 ---- 485
-----
1,142
=====
AURAL, NASAL, AND THROAT CASES
Acute catarrh (middle ear) 95
Chronic " " " 315
Cerumen 190
Dry catarrh (Eustachian) 120
Oto-sclerosis 138
Otitis externa 143
Concussion deafness 139
Nasal catarrh 114
Septal deflection 96
Adenoids 74
Polypi 4
Enlarged tonsils 12
Antra and sinuses 14
Pharyngeal catarrh 11
Aphonia 8
Laryngeal growth 1
-----
1,474
=====
OPERATIONS PERFORMED
Ophthalmic
Excision 36
Iridectomy and extraction 11
Removal F.B. 7
Pterygium 4
Minor operations 6
--
64
==
Aural
Mastoid operations 17
Removal F.B. 3
--
20
==
Nasal
Adenoids 73
Spurs 34
Polypi 14
Tonsils 41
---
162
===
Total performed, 246
The distribution of disease is unusual. In the course of a long and
extensive practice one of us (Lieut.-Col. Barrett) had not seen as many
cases of adenoids in adults as he examined in Egypt in three months. It
seemed that the irritation of the sand containing organic matter caused
inflammation and irritation of the naso-pharynx. Of ophthalmia there was
a great deal. It was usually of the Koch-Weeks variety, and gave way
readily to treatment. There were a few cases of gonorrhoeal ophthalmia,
two of which arrived from abroad, and all of which did well. After the
arrival of the wounded, however, a new set of problems made their
appearance. A limited number of men were totally blind, mostly from bomb
explosions, and a large number of others had received wounds in one eye
or in the orbit. It soon became evident that an eye punctured by a
fragment of a projectile is almost invariably lost. The metal is
non-magnetic. It is usually situated deep in the vitreous; it is
practically impossible to remove it even if the eye were not infected
and degenerate. A still more remarkable phenomenon, however, made its
appearance. If a projectile enters the head in the vicinity of the eye,
and does not actually touch it, in most cases the eye is destroyed.
Whether from the velocity or the rotation of the projectile, the
bruising disorganises the coats of the eye and renders it sightless. In
all such cases, if the projectile was lodged in the orbit, the eye was
removed together with the projectile. The total number of excisions was
thirty-six. In no case did a sympathetic ophthalmitis make its
appearance. The eyes were not removed unless the projection of light was
manifestly defective. A fuller account of the precise ophthalmic
conditions will be published elsewhere.
If the general physical examination of recruits was defective, it is
difficult to find suitable terms to describe the examination of their
vision. Instances were not infrequent where men with glass eyes made
their appearance, and there were several recruits who practically
possessed only one eye. Spectacle-fitting was the chief work, as many of
the recruits required glasses, mostly for near work, but sometimes for
the distance. Ultimately the War Office decided to provide the
spectacles. In such a war, it is impossible to exclude recruits for fine
visual defects, still, men with only one eye can hardly be sent to the
front.
One remarkable instance occurred. A man suffering from detachment of the
retina had but one effective eye. I gave directions that he should not
be sent to the front, but he eluded authority, and reached Gallipoli,
where he was hit in the blind eye with a projectile. I subsequently
removed the eye.
The work was excessive, but only one life was lost, though on occasion
the condition of some of the sufferers was grave to a degree. One of the
most remarkable cases of injury was that of a man who was struck below
the left eye by a bullet which emerged through the back of his neck, to
the side of the median line. The bullet in emerging tore away a large
quantity of the substance of the neck, leaving a hole in which a
fair-sized wine glass could have been placed. He was a cheerful man, and
sat up in bed propped with pillows, because of the weakness of his neck,
and observed to a visitor "Ain't I had luck!" He made an excellent
recovery.
[Illustration: HELIOPOLIS PALACE HOTEL: ROTUNDA AND PIAZZAS.
_To face page 97_]]
It is remarkable that there should have been so much refraction work,
and there is no doubt that a working optician, _i.e._ spectacle maker,
should accompany every army. Men are often just as dependent for their
efficiency on glasses as on artificial teeth, and in a war of this
character cannot be rejected.
The acute inflammations of the middle ear were of the most severe type,
caused temperatures rising to 103° F. and sometimes left men on
convalescence as weak as after a serious general illness. The attacks
were so vicious that the pathologist, Captain Watson, sought for special
organisms, but found only staphylococcus. Probably the same group of
organisms which caused vicious pulmonary attacks also caused these
severe aural inflammations.
Before our arrival in Egypt malingerers in the force who, having enjoyed
a holiday trip to Egypt, wanted to go home again, suddenly discovered
that they were blind or deaf. For a time the department was fairly busy
detecting the wiles of these men. When they discovered, however, that
they would be subjected to expert examination, sight and hearing soon
returned. A number of devices were resorted to in order to detect the
fraud--_i.e._ the use of faradisation, blind-folding, and the like--and
it was rarely that the impostor escaped.
OTHER DISEASES: MEASLES AND ITS COMPLICATIONS; FOOD INFECTIONS
The danger run by an army from measles is very great indeed, and at an
early stage the position was surveyed, and an attempt made to limit the
trouble. A cable message was sent to Australia, asking that precautions
should be taken against shipping measles cases or contacts. At Suez
arrangements were made with the Government Infectious Diseases Hospital
to admit any patients suffering from measles or infectious diseases who
might land with the recruits. In such cases the clothing of the
remaining recruits was disinfected before they were allowed to proceed
to Cairo. In this way disease was kept out of Egypt as much as possible.
In the case of measles it is not simply temporary disablement, but also
the complications and sequelæ which are to be feared. The experience
gained has made us converts to the open-air method of treating such
cases, at all events in a rainless country like Egypt. Treated on
piazzas and in open spaces the cases seem to do better than in hospital
wards, and, as far as one can judge without a critical examination, with
a lower mortality.
The extent to which the troops suffered from measles and other diseases
was the cause of the appointment of a committee to inquire into
causation. The committee made some inquiries, but owing to a set of
complications never completed its work. There seemed, however, to be a
consensus of opinion that the use of the bell tent was objectionable, as
it did not ventilate readily, and that the habits of the men contributed
to these diseases.
The men were apt to visit Cairo, spend the evenings in the cafés or
theatres, ride home in the cold nights in a motor car or tram, get to
bed at the last moment possible, and then turn out again for a hard
day's work. The opinion of the physicians was that the drilling of men
suffering from even a moderate cold was a source of considerable danger.
If to these causes be added the neglect of the teeth on the part of many
of the men, some explanation may be found for the presence of these
diseases. Every effort was made to instruct the men through the
regimental officers, and there is no doubt that as time went on the
quantity of this type of disease somewhat diminished.
Sunstroke was practically unknown. A number of cases occurred during a
severe khamsin, but the use of a looser and lighter uniform, and the
adoption of sensible hours of work, prevented any recurrence. Of two
deaths known to have taken place the cause was only partly due to heat.
The men were warned against the risk of bilharzia, and as they were
provided with shower baths there was no inducement to bathe in the muddy
pools and canals where bilharzia lurks.
With the provision of dentists another risk was removed, at all events
in parts. In hospitals, tooth brushes were supplied in thousands, and
every effort was made to get the men to use them.
As the summer wore on, however, another type of disease made its
appearance--the intestinal infections which, at first unknown, became so
frequent in Gallipoli as to be more serious than fighting. In Gallipoli
itself it is difficult to see how they could be prevented. In a limited
space there were many dead bodies scantily buried, and consequently
myriads of flies. The plentiful use of disinfectant, had it been
obtainable, might have been useful, but the difficulties were great.
Once the dysenteric organisms were introduced, it was practically
impossible to stop the spread of disease.
THE FLY PEST
At the Island of Lemnos, however, which was not under fire, and where
there was room, the conditions appear to have been nearly as bad, and
it is somewhat difficult to know why the fly pest could not have been
got under at Mudros. At Heliopolis at an early stage the fly problem was
seriously tackled. A sanitary officer was appointed, and charged with
the duty of dealing with this important matter. The following
precautions were adopted. All refuse and soiled dressings were placed in
covered bins, which were provided in quantity. These were removed once
daily. Any moist ground in the vicinity of these bins was watered with
sulphate of iron solution, and sprinkled with chloride of lime. Fly
papers in great numbers were distributed throughout the wards. The food
in the kitchens, whether cooked or uncooked, was kept under gauze covers
or in gauze cupboards. By these means the fly pest was reduced to small
proportions. But with the least slackness in administration the flies
were again in evidence. It was most instructive to see a floor covered
with flies if fluid containing food material had been spilled, and to
see dirty clothing covered with masses of flies. A piece of soiled
clothing half buried in the desert appears to act as an excellent
breeding-place.
It was impracticable in Egypt to cover all the windows and doors with
fly-proof netting. The exclusion of the air in the hot weather would
have been troublesome, and the best type of netting was not obtainable.
Furthermore the precautions already enumerated kept the pest under in
Heliopolis.
The fly problem was one of the most serious the army had to face. The
passage of a dysenteric stool by a man who is really ill was often
followed by the entry into his anus of flies before an attendant had
time to intervene. Each of these flies might then become a source of
infection and had only to light on a piece of food, cooked or uncooked,
to cause further damage.
CIRCULAR ISSUED BY THE OFFICER COMMANDING THE HOSPITAL
_Destruction and Prevention of Flies_
_Outside._
1. No rubbish heaps will be allowed.
2. All manure heaps shall be sprayed twice a week with sulphate
of iron--2 lb. to 1 gallon of water.
3. All food in the Arab quarters shall be kept in a closed
cupboard.
4. All rubbish boxes and open receptacles shall be removed from
the premises and neighbourhood.
5. No receptacles other than iron tins with lids kept closed
will be allowed to be used for refuse.
6. Every place on which garbage has been exposed shall be
freely sprinkled with chloriated lime.
_Wards._
1. All food and receptacles for food shall be kept constantly
covered.
2. All spit-cups shall be kept covered.
3. All remains of food shall be removed at once to receptacles
which are to be kept covered completely and constantly except
when uncovered necessarily to receive waste materials.
4. Sisters-in-Charge shall use a liberal quantity of fly
papers. Surgical soiled dressings shall be placed in special
bins which shall be kept covered.
_Kitchen and Mess Rooms._
1. All food shall be kept locked up or completely covered.
2. All remains of food shall be treated as in the wards. The
responsible officer shall use a liberal supply of flat or
hanging fly papers.
It need hardly be said that the enforcement of even these simple
precautions is more difficult than giving the order.
A good sanitary officer, however, acting on these directions, can and
did reduce the fly danger to small proportions. The flies were never
exterminated, but were kept well under. The least slackness, however,
ended in their rapid reappearance. As they are in all probability the
principal cause of the gastro-intestinal infections, the matter is one
of the first importance.
Typhoid fever made its appearance, and a proper statistical
investigation should be made later on to show the extent of the damage
done. The general impression respecting the result of the inoculation to
which all the troops were subjected was that the disease was not so
frequent and certainly not nearly so fatal as it otherwise would have
been. Deaths were few.
The men had not been inoculated against paratyphoid, so that exact
conclusions will be difficult to draw even when figures become
available.
Many people suffered from Egyptian stomach ache, a form of disease which
is as unpleasant as it is exhausting. It manifests itself by repeated
attacks of colicky pain, apparently usually associated with the colon.
The severity of the pains is remarkable, and the persistent recurrence
speedily ends in a considerable degree of exhaustion. It is almost
certainly due to food infection.
It is obvious that the business of a sanitary medical officer is not
merely to inspect buildings and kitchens, but to spend an hour or two a
day in the kitchen quietly watching the preparation of the food and
giving the necessary instruction and supervision to those who are
preparing it. The inefficiency caused by food infections has probably
done more harm than many battles. In the camps similar troubles
occurred. By reason of the lack of cold storage and the high
temperature, rotten food was not uncommon, and caused outbreaks of
incapacitating diarrhoea and ptomaine poisoning.
When, however, the problem is surveyed dispassionately, the remarkable
feature of the work at Heliopolis and in Cairo was the low mortality, as
the following table will show:
BURIALS IN OLD CEMETERY, CAIRO
_From Arrival of Australians in Egypt, December 5, 1914, to August 14,
1915_
British Imperial Force 77
Australian Imperial Force 155
New Zealand Force 50
In view of this extraordinarily low mortality, it is interesting to
comment on human intellectual frailty. It was said that the hospitals
were septic, that operations of election could not be performed with
safety, that the climate was particularly dangerous, and so forth. One
letter which reached us made reference to hundreds of deaths of brave
fellows due to faulty camp and hospital conditions. Yet here is the fact
recorded that the total deaths in Cairo amongst Australians from disease
and wounds to August 14 were only 155. All men tend to generalise on
insufficient instances, and the tendency in this case was aggravated by
some physical discomfort experienced by the generalisers throughout an
unusually warm summer--a discomfort accentuated by overwork and a
conscientious devotion to duty under trying conditions.
THE EGYPTIAN CLIMATE AGAIN
Dealing with the surgical side of the matter, nothing was commoner at
one time than to hear the statement made that owing to the hot weather
septic infections were common, that wounds did not heal as they should
in Egypt, and that it was not a suitable place to which wounded men
should be sent. While quite agreeing with the critics that a cool
climate is always preferable to a hot one, it may be remarked that in
the first place summer in Egypt, apart from the khamsin, is not
excessively hot. The khamsin blows for a certain number of days in
April, May, and the first half of June. The temperature may rise to 112°
or more. The wind blows with a fiery blast, and there is no doubt it is
exceedingly trying. But if buildings are shut up early in the morning
and opened at night, even the khamsin may be made tolerable. After the
middle of June, however, there is very little wind. One day is very
like another. The midday temperature is from 90° to 95° Dry Bulb, and
the nights perhaps 65° to 70° Dry Bulb. The Wet Bulb temperatures are
set out in the table previously referred to.
For the most part men slept in nothing but pyjamas. No sheet is wanted
until towards the end of August. Whilst it is not pleasant to wake in
the mornings in a lather, nevertheless, if a practical and cold-blooded
examination be made of the facts, the result shows nothing but
discomfort.
Grave septic diseases did not occur. The hospitals were perfectly clean,
and at Luna Park in particular we have the testimony of Colonel Ryan
that the wounds healed by first intention and that the cases did
excellently.
As the garrison of Egypt was a very large one, and as Australian troops
were continually pouring into it, it was impracticable even if it had
been necessary to take the patients anywhere else. The islands of Lemnos
and Imbros were far less suitable even for those who had been injured at
Gallipoli, and apart from the inconvenience caused by the heat there was
no reasonable ground for complaint in Egypt. Furthermore the heat is not
tropical. It is subtropical, as the Wet Bulb temperatures indicate.
In the First Australian General Hospital every care was taken to
minimise the inconvenience; a very large number of excellent ice chests
were purchased, an enormous quantity of ice was used, and the necessary
steps thus taken to diminish the amount of food decomposition and
prevent ptomaine poisoning. Fans and punkahs were used, and the nights
were quite tolerable.
MEDICAL ORGANISATION IN EGYPT
When the Australian forces pass three miles from Australian shores they
cease, at all events technically, to be under Australian control, and
pass under the control of the Commander-in-Chief. On arrival in Egypt
they passed under the control of General Sir John Maxwell,
G.O.C.-in-Chief, Egypt. The medical section passed under the command of
the Director of Medical Services, Surgeon-General Ford. The D.M.S.
Australian Imperial Force, Surgeon-General Williams, arrived in Egypt in
February and was placed on the staff of General Ford to assist in
managing these units. He left for London on duty on April 25, and one of
us (J. W. B.) was appointed A.D.M.S. for the Australian Force in Egypt
on the staff of General Ford. Later, Colonel Manifold, I.M.S., was
appointed D.D.M.S. for Australian and other medical units. Thus the
Australian medical units were under the same command as New Zealand or
British units, but with separate intermediaries.
THE RISK OF CHOLERA
In view of the risk of cholera, the following note by Dr. Armand Ruffer,
C.M.G., President of the Sanitary, Maritime and Quarantine Council of
Egypt, Alexandria, was issued and, later on, inoculation was practised
on an extensive scale.
DR. RUFFER'S VIEWS ON CHOLERA
(Report begins) "The first point is that although, in many epidemics,
cholera has been a water-borne disease, yet a severe epidemic may occur
without any general infection of the water supply. This was clearly the
case in the last epidemic in Alexandria. Attention to the water supply,
therefore, may not altogether prevent an epidemic. The second point is
that the vibrio of cholera may be present in a virulent condition in
people showing no, or very slight symptoms of cholera, _e.g._ people
with slight diarrhoea, etc.
The segregation of actual cases of cholera, therefore, is not likely to
be followed by any degree of success, because this measure would not
touch carriers or mild cases, unless orders were given to consider as
contacts all foreign foes, and all soldiers who have been in contact
with them. This is clearly impossible.
There cannot be any reasonable doubt, therefore, that if the Turkish
army becomes infected with cholera, the British Army will undoubtedly
become infected also.
Undoubtedly inoculation is the cheapest and quickest way of protection
of the troops, provided this process confers immunity against cholera.
It is very difficult to estimate accurately the protection given by
inoculation against cholera. My impression from reading the literature
on the subject is that: (1) The inoculations must be done at least
twice. (2) The inoculations, if properly made, are harmless as a rule.
(3) The inoculations confer a certain protection against cholera. I may
add that I arrived at this opinion before the war, when the French
editors, Messrs. Masson & Co., asked me to write the article "Cholera"
for the French standard textbook on pathology. My opinion was therefore
quite unprejudiced by the present circumstances.
The cholera inoculations were harmless _as a rule_; that is, _they were
not always harmless_. Savas has described certain cases of _fulminating
cholera_ amongst people inoculated _during the progress of an epidemic_.
In my opinion, the people so affected were in the period of incubation
when they were inoculated, and the operation gave an extra stimulus, so
to speak, to the dormant vibrio. One knows that, experimentally, a small
dose of toxin, given immediately after or before the inoculation of the
microorganism producing the toxin, renders this microorganism more
virulent.
The conclusion to be drawn is that inoculations should be carried out
before cholera breaks out.
I am afraid I know of no certain facts to guide me in estimating the
length of the period of immunity produced by inoculations. Judging by
analogy, I should say that it is certainly not less than six months,
that it, almost certainly, lasts for one year, and very probably lasts
far longer.
I understand that 90,000 doses of cholera vaccine have been sent from
London. I take it that the inoculation material has been standardised
and its effects investigated, but, in any case, I consider that a few
_very carefully performed_ experiments should be undertaken at once in
Egypt, in order to make sure of the exact method of administration to be
adopted under present conditions.
Probably, a good deal may be done by the timely exhibition of drugs,
such as phenacetin, etc., to mitigate the more or less unpleasant
effects of preventive inoculation.
As I am on this subject, may I point out the necessity of establishing
at the front a laboratory for the early diagnosis of cholera and of
dysentery. Cholera has appeared in the last three wars in which Turkey
has been engaged, and therefore the chances of the peninsula of
Gallipoli becoming infected are great. The early diagnosis of cases of
cholera, especially when slight, is extremely difficult and often can be
settled by bacteriological examination only.
There never has been a war without dysentery, and almost surely our
troops will be infected in time, if they are not already infected. But
whereas in previous wars the treatment of dysentery was not specific,
the physician is _now_ in possession of rapid methods of treatment,
provided he can tell what kind of dysentery (bacillary or amoebic or
mixed) he is dealing with.
This differential diagnosis is a hopeless task unless controlled at
every step by microscopical and bacteriological examination.
The French are keenly aware of this fact, so much so that they have
sent, for that very purpose, three skilled bacteriologists, two of whom
are former assistants at the Pasteur Institute, to the Gallipoli
Peninsula" (Report ends).
OTHER INFECTIOUS DISEASES
The Infectious Diseases Hospitals were filled mostly with cases of
measles and its complications, including severe otitis media. Cases of
erysipelas, scarlatina, scabies, and diphtheria were met with in small
numbers. In the autumn there was a severe epidemic of mumps.
Through the summer and autumn many cases of diarrhoea and of both
amoebic and bacillary dysentery made their appearance. There is good
ground for believing that many so-called diarrhoeal cases were
dysenteric.
There is little doubt short of absolute scientific proof that the
greater part of the intestinal diseases are fly borne.
The following table shows the admissions into the hospital, the deaths,
and causes of death, to July 31, 1915.
A subsequent table shows the deaths and causes of death in No. 2
Australian General Hospital from May 3 to August 18.
ADMISSIONS AND DEATHS INTO NO. 1 AUSTRALIAN GENERAL HOSPITAL
_From February to July inclusive_
---------+-----------+-------------+-----------------------------------
|Admissions.| Deaths. | Cause of Death.
---------+-----------+-------------+-----------------------------------
February | 1,360 | 1 | Malignant purpura
March | 1,791 | 12 | 6 Pneumonic group
| | | 3 Measles, etc.
| | | 1 Meningitis
| | | 1 Abscess, liver
| | | 1 Tumour, brain
April | 1,343 | 12 | 2 Pneumonic group
| | | 7 Measles, etc.
| | | 1 Meningitis
| | | 1 Septicæmia
| | | 1 Injury
May | 2,650 | 35 | 27 Wounds (1 tetanus)
| | | 1 Meningitis
| | | 1 Poliomyelitis
| | | 1 Cardiac
| | | 1 Pancreatitis
| | | 1 Appendicitis
| | | 3 Pneumonic group
June | 2,862 | 20 | 11 Wounds
| | | 1 Perinepritis
| | | 1 Nephritis, chronic
| | | 1 Septicæmia
| | | 1 Broncho-pneumonia endocarditis
| | | 1 Pneumonia
| | | 1 Meningitis
| | | 2 Enteric
| | | 1 Dysentery
July | 2,099 | 19 | 6 Wounds
| | | 1 Fracture, tibia
| | | 1 Enteric
| | | 6 Dysentery
| | | 1 Diphtheria
| | | 3 Meningitis
| | | 1 Enteritis
---------+-----------+-------------+-----------------------------------
In May and June 5,512 men were admitted, of whom 1,219 were Australians
and New Zealanders in camp, 2,967 Australians and New Zealanders from
the Mediterranean Expeditionary Force, 1,050 British, and 276 Naval
Division from the same force.
AUSTRALIAN IMPERIAL FORCE
_Return showing Number of Deaths at No. 2 Australian General
Hospital, Ghezireh_
_From May 3, 1915, to August 18, 1915_
AUSTRALIAN M.E.F.
Sickness 2
Wounds in Action 9
BRITISH M.E.F.
Sickness nil
Wounds in Action 1
R.N.D. M.E.F.
Sickness 1
Wounds in Action nil
NEW ZEALAND M.E.F.
Sickness 1
Wounds in Action nil
AUSTRALIAN FORCE IN EGYPT
Sickness 1
D. MACKENZIE, _Captain_.
_Secretary and Registrar, No. 2
General Hospital._
GHEZIREH,
_August 18, 1915_.
This chapter would be incomplete unless proper acknowledgment were made
of the most valuable post mortem demonstrations given by Major Watson.
CHAPTER VIII
VENEREAL DISEASES--THE GREATEST PROBLEM OF CAMP LIFE IN
EGYPT--CONDITIONS IN CAIRO--METHODS TAKEN TO LIMIT
INFECTION--MILITARY AND MEDICAL PRECAUTIONS--SOLDIERS' CLUBS.
CHAPTER VIII
The venereal-disease problem has given a great deal of trouble in Egypt
as elsewhere. The problem in Egypt does not differ materially from the
problem anywhere else, but a number of fine soldiers have been disabled
more or less permanently.
When the First Australian Division landed in Egypt and camped at Mena,
the novelty of the surroundings and the lack of intuitive discipline
resulted in somewhat of an outbreak, both with regard to conduct and to
sexual matters. Both of these phases have been greatly exaggerated, but
nevertheless there was substantial ground for apprehension, and the
following letter from General Birdwood, Commander-in-Chief of the
Australian Army Corps, to the officers commanding units was sufficient
evidence of the necessity for action.
"_For Private Circulation only_
"DIVISIONAL HEADQUARTERS, MENA,
"_December 18, 1914_.
"The following letter written by Major-General W. R. Birdwood, C.B.,
C.S.I., C.I.E., D.S.O., Commanding the Australian and New Zealand Army
Corps, to Major-General W. T. Bridges, C.M.G., Commanding the First
Australian Division, has been printed for private circulation.
"V. C. M. SELLHEIM,
"_Colonel, A.A. and Q.M.G._"
"HEADQUARTERS: AUSTRALIAN AND NEW ZEALAND ARMY CORPS,
"SHEPHEARD'S HOTEL, CAIRO,
"_December 27_, 1914.
"MY DEAR GENERAL,
"You will, I know, not misunderstand me if I write to you about the
behaviour of a very small proportion of our contingents in Cairo, as I
know well that not only you, but all your officers and non-commissioned
officers and nearly all the men must be of one mind in wishing only for
the good name of our contingents.
"Sir John Maxwell had to write recently complaining of the drunkenness
of some of our men in the Cairo streets. During Christmas time some
small licence might perhaps have been anticipated, but that time is now
over, and I still hear of many cases of drunkenness, and this the men
must stop.
"I advisedly say 'the men must stop,' because I feel it is up to the men
themselves to put a stop to it by their own good feeling. I wonder if
they fully realise that only a few days' sailing from us our
fellow-countrymen are fighting for their lives, and fighting as we have
never had to do before, simply because they know the very existence of
their country is at stake as the result of their efforts.
"We have been given some breathing time here by Lord Kitchener for one
object, and one object only--to do our best to fit ourselves to join in
the struggle to the best advantage of our country. I honestly do not
think that _all_ of our men realise that this is the case. Cairo is full
of temptations, and a few of the men seem to think they have come here
for a huge picnic; they have money and wish to get rid of it. The worst
of it is that Cairo is full of some, probably, of the most unscrupulous
people in the world, who are only too anxious to do all they can to
entice our boys into the worst of places, and possibly drug them there,
only to turn them out again in a short time to bring disgrace on the
rest of us.
"Surely the good feeling of the men as a whole must be sufficient to
stop this when they realise it. The breathing time we have left us is
but a short one and we want every single minute of it to try and make
ourselves efficient. We have to remember too that our Governments of the
Commonwealth and Dominion have sent us here at a great sacrifice to
themselves, and they fully rely on us upholding their good name, and
indeed doing much more than that, for I know they look to us to prove
that these two contingents contain the finest troops in the British
Empire (whose deeds are going down in history), whom they look forward
to welcome with all honours when we have done our share, and I hope even
more than our share, in ensuring victory over a people who would take
all we hold dear from us if we do not crush them now.
"But there is no possibility whatever of our doing ourselves full
justice unless we are every one of us absolutely physically fit, and
this no man can possibly be if he allows his body to become sodden with
drink or rotten from women, and unless he is doing his best to keep
himself efficient he is swindling the Government which has sent him to
represent it and fight for it. From perhaps a selfish point of view,
too, but in the interests of our children and children's children, it is
as necessary to keep a 'clean Australia' as a 'White Australia.'
"A very few men can take away our good name. Will you appeal to all to
realise what is before us, and from now onwards to keep before them one
thought and only one thought until this war is finished with
honour--that is, a fixed determination to think of nothing and to work
for nothing but their individual efficiency to meet the enemy.
"If the men themselves will let any who do not stick to this know what
curs they think them in shirking the work for which it has been their
privilege to be selected, then, I know well, any backslidings will stop
at once--not from thoughts of punishments, but from good feeling, which
is what we want.
"I have just been writing to Lord Kitchener telling him how intensely
proud and well-nigh overwhelmed I feel at finding myself in command of
such a magnificent body of men as we have here; no man could feel
otherwise. He will, I know, follow every movement of ours with unfailing
interest, and surely we will never risk disappointing him by allowing a
few of our men to give us a bad name. This applies equally to every one
of us, from General down to the last-joined Drummer.
"Will you and your men see to it?
"Yours very sincerely,
"W. R. BIRDWOOD."
Those who possessed any experience of life could not but realise that
18,000 particularly vigorous fine men, brought up in a country where
discipline is conspicuous by its absence, and landed for the first time
in a semi-eastern city such as Cairo, were likely to behave in such a
manner that a small minority would get into trouble. Active steps were
taken to meet the difficulties, and to prevent recurrence of the
outbreaks when the Second Division and other reinforcements arrived.
General Birdwood accordingly issued the following circular:
"WARNING TO SOLDIERS RESPECTING VENEREAL DISEASE
"Venereal diseases are very prevalent in Egypt. They are already
responsible for a material lessening of the efficiency of the
Australasian Imperial Forces, since those who are severely infected are
no longer fit to serve. A considerable number of soldiers so infected
are now being returned to Australia invalided, and in disgrace. One
death from syphilis has already occurred.
"Intercourse with public women is almost certain to be followed by
disaster. The soldier is therefore asked to consider the matter from
several points of view. In the first place if he is infected he will not
be efficient and he may be discharged. But the evil does not cease even
with the termination of his military career, for he is liable to infect
his future wife and children.
"Soldiers are also urged to abstain from the consumption of any native
alcoholic beverage offered to them for sale.
"These beverages are nearly always adulterated, and it is said that the
mixture offered for sale is often composed of pure alcohol and other
ingredients, including urine, and certainly produces serious
consequences to those who consume it. As these drinks are drugged, a
very small amount is sufficient to make a man absolutely irresponsible
for his actions.
"The General Commanding the Australasian Forces, therefore, asks each
soldier to realise that on him rests the reputation of the Australasian
Force, and he is urged at all costs and hazards to avoid the risk of
contracting venereal disease or disgracing himself by drink."
* * * * *
This leaflet was entrusted to Lieut.-Col. Barrett to deliver to troops
on arrival, and he accordingly visited Port Said and Suez, interviewed
the officers on the transports, and fully explained the position to
them. They were requested to use their influence with the men in the
direction of restraint. Subsequently after the destruction of the
_Konigsberg_ the transports began to arrive at irregular intervals and
it became impossible to meet the officers at the ports. They were then
interviewed at Abbassia or Heliopolis, and later still by order of
General Spens, G.O.C. Training Depot, the men themselves were
addressed on the day of their arrival. The form of address was simple.
The dangers of infection were pointed out to them--particularly as
regards typhoid fever, dysentery, bilharzia, and venereal disease. They
were shown how the first three diseases could be avoided. So far as
venereal disease was concerned they were informed that the matter was in
their own hands. They were asked to imitate the Japanese, and by their
own efforts preserve their health with the same care that they bestowed
on their rifles or their ammunition, the preservation of health and arms
being equally important. Passages from the famous rescript of the
Emperor of Japan before the Russian war were quoted in which it was
stated in substance that if the normal proportion of sick existed in the
Japanese army defeat was a practical certainty; but that if they
followed the direction of their medical officers and took the same care
of their bodies as they took of their equipment, the number of troops
saved thereby would make all the difference in the ensuing conflict.
[Illustration: VENEREAL DISEASES HOSPITAL, ABBASSIA.
_To face page 120_]]
General Birdwood asked for the whole-hearted and enthusiastic
co-operation of all officers in doing their best to control their men,
and to prevent them from exposing themselves to the risk of venereal
disease. Some little time before the issue of the circular 3 per cent.
of the Force were affected by venereal disease on any one day.
Fortunately, as a result of the efforts made, the tendency was to
diminution, but the amount of venereal disease was still sufficiently
great to give concern and anxiety.
There is no doubt that the action of General Birdwood prevented
outbreaks and limited the amount of disease. It is also equally true
that in spite of his efforts the amount of disease was too large to be
contemplated with equanimity.
The Venereal Diseases Hospital, Abbassia, was nearly always full, but
from time to time drafts of men were sent back to Australia. One draft
of 450 soldiers was sent to Malta early in the campaign. The principle
involved in the policy of returning them to Australia was as follows. In
Egypt they were useless as soldiers, whether suffering from gonorrhoea
or syphilis. They required a large number of medical men and attendants
to take care of them. They knew they had disgraced themselves and were a
source of trouble to every one concerned. On shipboard they could not
get into trouble. They were more likely to be cured, and could then be
returned to Egypt, and if not cured could be treated in Australia at
leisure. Against this policy the argument was used that diseases were
being introduced into Australia, but as a matter of fact a minority of
the men suffering from venereal disease brought it from Australia to
Egypt. They arrived at Suez suffering from gonorrhoea contracted in some
cases at Fremantle. Furthermore the business of those conducting the
campaign was to wage a successful war, and to keep the base as free from
encumbrance as possible. The total number returned to Australia in this
way was as follows:
From February to September 14, 1,344, and in addition 450 were sent to
Malta.
At first they were sent in ships with other cases and sometimes
segregated on board, but difficulties arose at the Australian ports. The
people who welcomed the returned soldiers were sometimes enthusiastic in
greeting venereal cases by mistake, and sometimes non-venereal cases
were regarded with suspicion because they came from a ship known to
convey venereal patients. It was finally decided by the Australian
Government that venereal cases should be conveyed in ships by
themselves, the first consignment of 369 being sent in the _Port
Lincoln_.
A certain number of the gonorrhoeal cases recovered and became fit for
service, but too often they relapsed.
The authorities were fully alive to the damage which was being done, and
persistent and earnest attempts were made to deal with it from many
different points of view. General Maxwell issued an order prohibiting
the sale of drink after an early hour (10 p.m.) in the evening, and also
prohibiting soldiers from being found in Cairo after an early hour.
There is no doubt that both of these directions proved to be of
considerable value.
MORAL CONDITIONS IN CAIRO
Something must be said, however, about the moral conditions in Cairo,
about which exaggerated and perverse notions seem to be entertained.
Cairo, like all large cities in the world, possesses its quota of
prostitutes, who differ only from prostitutes elsewhere in that the
quarters are dirtier and that the women are practically of all
nationalities, except English. The quarter in which they live is
evil-smelling, and is provided with narrow streets and objectionable
places of entertainment. It contains a considerable infusion of Eastern
musicians and the like, and is plentifully supplied with pimps of the
worst class. These men were promptly dealt with by the police, the
authorities giving the most sympathetic assistance to the military.
As in other countries, there were graduations in the class of women
employed, and the personal impression gained by the authorities was that
the danger of infection was greatest from those at the top and the
bottom of the social scale. Prostitutes who were registered were
examined by a New Zealand gynecologist, who did the work very
thoroughly, and conscientiously, and with kindness. Women who were free
from disease were furnished with a ticket indicating that they were
healthy. At the beginning of the war there were 800 of these women in
Cairo, but as the war progressed the number grew to 1,600. The
arrangement then differed in no way from the arrangements in Melbourne
or Sydney except that the surveillance of the police was direct, and
medical examination was insisted upon. It further had this advantage
over those of Melbourne and Sydney, that the women were confined to one
particular part of the city, and no one need come in contact with them
unless they wanted to. Consequently for those who went to this quarter
there is no excuse, since they acted deliberately.
PROPHYLAXIS
At the same time, when all these measures were weighed in the
balance--plain speaking to the men on arrival, police surveillance,
medical examination, etc.--it was felt that more might be done. A number
of medical officers accordingly gave instruction to their men in the
means of effecting prophylaxis and of preventing infection in the event
of association with these women. The medical officers acted entirely on
their own responsibility. They advised the men to avoid the risk, but as
they knew a certain number would not take their advice in any
circumstances--in fact the men said as much--they showed them how to
avoid infection if they would take the necessary trouble.
RESULT OF PROPHYLAXIS
In the case of our own unit, the First Australian General Hospital,
trouble was taken to explain in detail the consequences of venereal
diseases to the men, and to those with whom they would be associated in
later life. They were asked to refrain from taking the risk, but for
those who would not take the advice--and there was bound to be a
percentage--the necessary directions and material were provided for
preventing infection. The result was challenged by a medical officer,
and an immediate examination of all the men made, when it was found that
in the whole of the unit only one man was infected. In other words, the
precautions taken had practically stamped the disease out of the unit,
and shortly after arrival in Cairo.
Once the disease was acquired the treatment was troublesome to a degree.
The men knew they were disgraced; they would probably be sent back to
Australia; and in some cases, those of the finer men, the consequences
were serious. Mostly, however, they developed an attitude of sullenness
and indifference, a tendency to lack of discipline, and they rendered
the management of camps difficult. These troubles to a large extent
disappeared when a suitable hospital was established.
SOLDIERS' CLUBS
But another and constructive side of the matter appealed forcibly to
those concerned. Why not supply for the benefit of the men places of
entertainment with music, refreshments, and the like, similar to and
better than those which the prostitutes supplied, but minus the
prostitute. In other words, why not give a healthy and reasonable
alternative? After consultation with His Excellency Sir Henry MacMahon,
with the G.O.C.-in-Chief, General Sir John Maxwell, and with the D.M.S.
Egypt, General Ford, the Australian Red Cross Society determined to
combine with the Y.M.C.A. and establish clubs for the soldiers in
central positions where these requirements would be met. They
accordingly established a club at the quay in Alexandria, and a
magnificent open-air club in the Esbekieh Gardens, Cairo. They were both
immediately successful, and have played a most important part in the
further limitation of the amount of venereal disease. It is difficult to
give statistical evidence, but there is no doubt that by these various
means a sensible difference has been produced in the incidence of
disease amongst the troops.
THE DUTY OF THE MEDICAL OFFICER
We have never wavered from the conviction that any one suffering from
venereal disease should be treated by a medical practitioner exactly
like any other sick person. In military service, however, an added
element makes its appearance in that the soldier by his act has rendered
himself unfit, and consequently must suffer some pains and penalties. It
is no answer to say that other men have exposed themselves and have not
become infected. The fact remains that he has by a deliberate and
avoidable act deprived his country of the value of his services. And
whilst the doctrine of punishment should not be pushed too far, he
certainly should not receive the same general treatment as other
soldiers, and the policy of his prompt return to Australia and
deprivation of pay was in the circumstances the best one.
In the Venereal Diseases Hospital, Abbassia, the men were well treated.
They were well fed, and a certain amount of Red Cross help was given to
them.
Many proposals were made which were not carried into effect: for
example, placing of the prostitute quarter "out of bounds" and the
posting of sentries. It was realised that the immediate effect of this
action would have been to drive women to the vicinity of the camps, and
that it was impracticable. Another practicable proposal was made, which,
however, was not carried into effect--the creation of dispensaries in
the vicinity of the prostitute quarter, so that immediate treatment
could be obtained. In many camps such dispensaries were established by
the medical officers.
The essence of the problem was learnt by a Brigadier-General who visited
a number of young educated men in one of the camps, and asked them for
their viewpoint on the subject. Their answer was that which every
medical officer knows full well: that many men were influenced by the
appeals which had been made to them, but that a percentage have indulged
in this way throughout their adult life, and intend to continue to do so
irrespective of anything medical officers, chaplains, or generals may
say to them. It is this fundamental position which every reformer must
face. So long as a sufficient number of men determine to adopt this
policy, and so long as there is a sufficient number of women prepared to
cater for them, the problem of venereal disease will continue to be
acute in every country.
The opinion has been expressed elsewhere that the world will not be
rendered more or less moral by the abolition of venereal disease, and
instruction in the mode of preventing infection should be an essential
part of education. Because people are immoral there is no reason why
they should acquire gonorrhoea or syphilis. If the _lex talionis_ is to
be enforced, the logical way to deal with the matter is to refuse
treatment to all the infected, and to let them die or become disabled.
But the most thorough-going Puritan shrinks from adopting so terrible a
policy. One method or the other, however, must be adopted--there can be
no half-way house. And if the decision be in favour of eradicating the
disease, it is essential to firmly face and grapple with the problem.
WASSERMANN TESTS
The examination of the cases showed that gonorrhoea was far more common
than syphilis, and a series of Wassermann determinations showed that the
cases of soft sores did not give a syphilitic reaction in the early
stages. Captain Watson of the First General Hospital made a number of
determinations in order to try to settle this important point.
THE POLICY TO BE ADOPTED
In spite of all that was done, 1,344 men were returned to Australia
disabled, and 450 were sent to Malta. If a calculation be made of the
cost of sending these men to Egypt and back, and of their pay before
they were infected, some idea may be formed of the enormous sum of money
the Australian Commonwealth wasted on men who were a drag and hindrance
to the army machine.
The Government should, on the raising and equipping of a volunteer
army, treat it as older countries treat a standing army by issuing
instructions to the men.
When the Hospitals left Australia neither officers nor men received
instructions, and not until the arrival of Surgeon-General Williams in
Egypt was any serious collective action taken. He at once called a
conference of medical officers and did what he could to limit the extent
of disease.
The governmental action--or lack of action--is unsound, since the man
who contracts disease is severely punished, but adequate attempts are
not made to prevent him acquiring it. The notable departure made in the
case of Cairo was the effort to make the men understand clearly what
these diseases meant to them as soldiers and as citizens; to remove
temptation from them as far as possible, and with the aid of the
Australian Red Cross to give them a reasonable, healthy, and decent
alternative. Nothing the Australian Red Cross has done (or is likely to
do) is more important than the establishment of the Soldiers' Clubs.
Nothing has been more successful or is likely so to redound to the
credit of that great institution. And yet, under the new Constitution of
the Australian Red Cross, not a shilling can be devoted in the future to
such purposes.
VENEREAL DISEASES CONFERENCE
The following are brief notes of a Conference of senior medical officers
convened by Surgeon-General Williams.
Reference was made to the gravity of the problem with which the force
was faced. It was estimated that about 1,000 men of the First and Second
Australian Divisions are suffering from venereal disease on any one day,
and of these a large number are incapacitated from work. The proportions
seemed to be much greater than those of other forces, such as the
Territorials, in Egypt. The displacement of so large a proportion of men
and the ultimate consequence of numerous infections, rendered it
necessary to take a comprehensive view of the position, and to endeavour
to take some action to minimise the damage done. It was proposed to ask
each officer present to furnish the secretary with a general statement
of the number of cases treated under their command, specifying them
under three headings--syphilis, soft chancre, and gonorrhoea. The
information so obtained would form the basis of a report to
headquarters. The problem was considered under five headings:
1. Military assistance.
2. Use of prophylaxis.
3. Treatment--general and special.
4. Establishment of convalescent depots--accommodation and position.
5. Ultimate destination of affected men.
1. _In what way can the military authorities give assistance?_--There
are three ways in which they can approach the problem:
(_a_) They may decide that all areas known to contain brothels
are out of bounds.
(_b_) They can provide adequate military control by military
police organised under a competent officer, with one or more
junior medical officers to assist him.
(_c_) That punishment can be inflicted on those men who break
bounds and expose themselves to the risk of venereal infection.
It might be desirable to reduce the pay of men found in those
areas whether suffering from venereal disease or not.
2. _Prophylaxis._--Officers were invited to discuss the question whether
it would not be advisable to establish prophylactic depots in various
parts of Cairo. Men to report immediately after exposing themselves to
infection, and by cleanliness and the use of medicaments prevent
infection. Circulars couched in plain and sensible language might be
issued to the troops, conveying to them a knowledge of the risk they
run, and the fact that if infected they will take back to Australia a
disease which would reduce their value as citizens.
3. _General and Special Treatment._--Suggestions from officers present
were invited.
4. _Convalescent Depots._--Was it right that the hospital should be
crowded out with venereal cases, which demanded very much time and
attention from the staffs? If the hospital was placed near the scene of
military action the wounded might suffer from the amount of attention
required for venereal cases. Most venereal cases required rest in the
main, and this could be obtained in convalescent depots.
5. _The ultimate destination of the affected men._--Two courses are
open: The men may be treated in Egypt, or sent back to Australia.
(_a_) If they are kept in Egypt and the Australian Expeditionary
Force is moved to the front its medical services would be
depleted, and medical men of great ability and experience would
be left behind to take charge of venereal cases when their
services were required at the front.
(_b_) If on the other hand the Australian and Imperial
Government could utilise some ships for the accommodation of
these men, those who were cured could be sent to the front, and
those who could not be cured could be sent back to Australia at
once. But such ships would require special staffing so that the
existing units should not be depleted in order to provide
staffs.
In the discussion which ensued it was represented that there was a
difficulty in placing areas out of bounds, as the brothels would be
moved to other areas. Prophylaxis was regarded as most important.
Isolation tents could be set apart in the regimental lines where men
could be treated on return from leave. Cases of syphilis should be sent
to Australia.
The reduction of pay is forbidden by King's Regulations, and although
the Minister for Defence in the Commonwealth of Australia authorised
such reduction, it is only for such period as the troops are in Egypt.
It was agreed that cases of syphilis should be returned to Australia, as
there is no chance in Egypt of treating them efficiently, and even if
such treatment were available the men would not be fit for duty for from
four to six months.
It was pointed out that at least 100 men left Australia with the First
Division suffering from venereal disease.
[Illustration: SOLDIERS' CLUB, ESBEKIEH, CAIRO.
_To face page 133_]]
The chief difficulty seemed to be what venereal cases would ultimately
be of service to a fighting line, and to properly arrange for them
during convalescence; in other words, when and how men considered unfit
for further service should be returned to Australia. Officers were asked
to recollect that the future of these soldiers was to be considered and
the part they would play in civil life. In the American Navy unbounded
shore leave had been given, and had some effect in checking the disease.
In the British Navy it was an offence not to report "exposure."
* * * * *
The Soldiers' Clubs are fully described in the chapter on the Red Cross.
They were rendered possible by an alliance between the Y.M.C.A. and the
Australian Branch British Red Cross. To the Y.M.C.A., who managed them,
the best thanks of Australia should be given, for Australians will never
fully know what they owe to Mr. Jessop and his assistants.
Unfortunately, the Australian Branch British Red Cross subsequently
decided that help should be given _only_ to sick and wounded. Although
convalescents frequent these clubs, the view was taken--we think
wrongly--that Red Cross funds could not be used for their support. We
feel sure that when Australians fully understand the matter the decision
will be reversed.
CHAPTER IX
THE RED CROSS WORK: ITS VALUE AND LIMITATIONS--ORIGIN IN
AUSTRALIA--REPORT OF EXECUTIVE OFFICER IN EGYPT--RED CROSS
POLICY--DEFECTS OF CIVIL AND THE ADVANTAGES OF MILITARY
ADMINISTRATION--WHAT WAS ACTUALLY DONE IN EGYPT.
CHAPTER IX
The British Red Cross Society, Australian Branch, was founded by Her
Excellency Lady Helen Munro Ferguson, wife of the Governor-General of
Australia, on the outbreak of war. On previous occasions unsuccessful
attempts had been made to found an Australian Red Cross Society. On this
occasion the movement was most successful, although many people then
(like some people now) were quite unable to understand the distinction
between the Red Cross movement and military administration.
The Red Cross Society in Australia undertook the collection of funds for
immediate transmission to the British Red Cross Society for prompt use
in the field. Branches were formed in each State and committees were
formed by the wives of the various governors. Thus a rough-and-ready
arrangement was made prior to the adoption of a constitution. It was
considered far more important to do the work than to waste time holding
meetings and devising a constitution. Those who could not afford to give
money were invited to make clothing or to contribute articles of various
kinds. Specifications of the clothing requisite were given, and patterns
furnished so that it might be readily made on approved design. It is not
too much to say that the majority of the inhabitants of the Continent
were soon engaged in some way or other in helping the Red Cross
movement. The ball-rooms of the respective Government Houses were used
as depots. The depot at Federal Government House, Melbourne, was an
excellent model. People were invited to send their donations
irrespective of their number or their kind. These were received and
receipted, and were then sorted into bundles of similar articles by lady
volunteers. They were then placed in cases by volunteer packers, mostly
experienced men from various warehouses, and were finally dispatched to
Europe as opportunity offered.
The arrangement of these details fell largely on the Council and
Secretary of the Branch (one of us, J. W. B.) in Australia acting under
the direction of the President, Her Excellency Lady Helen Munro
Ferguson. Very great difficulty was experienced in finding space in
merchant ships for the conveyance of the goods. Space was found on the
transports, but there was not the same security for delivery. In
addition the hospitals of the transports were provided with such
equipment as the officers commanding desired.
When, however, the Lines of Communication Units were ordered to Egypt,
another problem arose, and the Australian Red Cross Society decided to
properly equip these units both with money and goods. For this purpose
£10,000 was set aside and forwarded to London. It was handed to the
British Red Cross Society and kept available for the officers commanding
the five hospitals, the requisite sum of money to be allotted to them by
Surgeon-General Williams, C.B., the Director of Medical Services in
Australia, who had proceeded to Europe. At the time it was supposed that
these five hospitals were proceeding to France. In addition large
quantities of goods were available at the British Red Cross Society in
London, and large quantities of goods were given to the several
hospitals for dispatch with their equipment. When, however, the
hospitals were sent to Egypt a new situation arose. There were many
other medical units in Egypt besides the hospitals. There were the Field
Ambulances and the Regimental Medical Officers, and Surgeon-General
Williams regarded them as equally worthy of assistance. On his arrival
in Egypt at first, in December, and subsequently in the middle of
February, the scope of the British Red Cross, Australian Branch, in
relation to Australian troops had extended far beyond the original
intention. The action taken is described in the following report sent to
the President and members of the Council, British Red Cross Society,
Australian Branch, on my resignation (Lieut.-Col. Barrett) from that
body on September 9, 1915. I did not at any time receive any
instructions from Australia, and acted in the manner which seemed best
after consultation with local authorities.
REPORT ON THE WORK OF THE AUSTRALIAN BRANCH BRITISH RED CROSS IN
EGYPT, FROM MARCH TO SEPTEMBER 3, 1915
_By_ JAMES W. BARRETT, _Lieut.-Colonel, Lately Executive
Officer, Australian Branch British Red Cross Society_
REPORT PRESENTED TO THE PRESIDENT AND MEMBERS OF THE COUNCIL OF
THE AUSTRALIAN BRANCH BRITISH RED CROSS SOCIETY
The First Australian General Hospital arrived in Egypt in January 1915.
I was associated with it as Registrar and Oculist and had nothing to do
with the Red Cross movement beyond assuming responsibility for any Red
Cross goods which belonged to the Hospital.
When leaving Melbourne Colonel Ramsay Smith was informed that there
would be room for 100 tons of Red Cross goods in the _Kyarra_. When,
however, the _Kyarra_ reached Melbourne her holds were full and no Red
Cross goods were taken on board. There were consequently not any Red
Cross goods available at No. 1 Australian General Hospital for some
considerable time after arrival in Egypt.
Surgeon-General Williams, C.B., arrived in Egypt in the middle of
February, and at once proceeded to organise the Red Cross movement. He
had been entrusted with £10,000 which was to be expended by the officers
commanding medical units according to the plan set out later. He at once
took action, and money was distributed to a number of hospitals and
medical units. This distribution was of the utmost service.
[Illustration: HELIOPOLIS PALACE HOTEL.
_To face page 141_]]
When Red Cross goods began to arrive in Egypt he sought a suitable
store. Finding nothing in Cairo at a reasonable price, he established a
store in the basement of the Heliopolis Palace Hotel, No. 1 Australian
General Hospital, for which, of course, no rental was charged. The store
was placed under the immediate charge of the Orderly Medical Officer,
Captain Max Yuille, and under my general direction. The distribution of
money and collection of goods from ships was effected by General
Williams through his own office in Cairo.
General Williams left for London on duty on April 25, leaving me in
charge of the Red Cross work, and leaving his Warrant Officer, Mr.
Drummond, in his office to continue the collection of goods and the
clerical work.
Soon after he had left, the crisis of May and June took place. Wounded
and sick were poured into Cairo on a scale probably never known or
equalled before. There have been occasions on which a much larger number
of men have been wounded, but probably never any occasion in history in
which so many wounded men have been handled in so limited a space.
Fortunately preparation had been made by the D.M.S. Egypt,
Surgeon-General Ford, D.S.O., and the D.M.S. A.I.F., Surgeon-General
Williams, C.B., who instructed the O.C. First Australian General
Hospital, Colonel Ramsay Smith, and myself as registrar to take over
extra buildings and provide equipment. It was this action which
prevented a disaster, and whilst not strictly a Red Cross matter was
greatly aided by Red Cross equipment.
During this crisis I was instructed by the D.M.S. Egypt, Surgeon-General
Ford, and the O.C. Australian Intermediate Base, Colonel Sellheim, to
visit various hospitals in Egypt--both in Alexandria and the
provinces--to interview the Australian wounded and supply all reasonable
comforts. In accordance with this order, money and goods, either or
both, were sent to various hospitals as set out in the various tables.
It so happened that the British Red Cross Society possessed neither
money nor goods at the inception of the crisis, and the authorities were
profoundly grateful for the help which the Australian Branch afforded.
The British Red Cross, Egyptian Branch, at a later stage received large
supplies of money and goods which were freely distributed. The fact that
goods could be obtained from the British Red Cross Society, Australian
Branch, soon became known, and many requisitions were received. The list
of goods available was widely circulated and in no instance was the
requisition of any Officer Commanding not complied with. It was always
completed to the extent of our resources. Periodical reports of the work
done were prepared and forwarded to the President of the Australian
Branch British Red Cross Society, Melbourne.
Whilst the work was at its height a message from Australia reached His
Excellency Sir Henry MacMahon, in consequence of which two Committees
were formed on June 3, 1915--a General Egyptian Committee and an
Executive Committee.
The members were:
{ President, His Excellency Sir Henry MacMahon.
General { Lord Edward Cecil.
Committee { Sir Alexander Baird.
{ Sir Courtauld Thomson.
{ Sir John Rogers.
Executive { Dr. Ruffer.
Committee { Surgeon-General Williams.
{ Lieut.-Colonel Barrett.
Sir Courtauld Thomson is the Commissioner in the Mediterranean for the
British Red Cross Society, and Sir John Rogers and Dr. Ruffer Deputy
Commissioners in Egypt.
Surgeon-General Williams and Lieut.-Col. Barrett were appointed members
of the Executive Committee of the British Red Cross Society in Egypt.
There was no amalgamation of the two branches, but by this arrangement
each was kept informed of the activity of the other and wasteful
overlapping was avoided.
Members of the General Committee investigated the work of the Australian
Branch, were consulted in matters of policy, and received and
investigated any complaints. They were most helpful.
General Williams returned to Egypt on June 21, made a tour of
inspection, and visited the Australian wounded. He reported to the
Government, and finally left for London on duty on June 29. On this
occasion he took with him his office staff, and consequently the
administration fell largely into my hands.
On July 13, however, I learned by cable from Australia that two
Commissioners had been appointed in terms which seemed to place them in
entire control of the Red Cross movement.
As it was desirable that other medical officers should be associated
with the movement. Colonel Ryan, Colonel Martin, and Lieut.-Col.
Springthorpe were invited by His Excellency Sir Henry MacMahon to join
the Executive Committee.
Mr. Adrian Knox, K. C., the first of the Commissioners, arrived in Cairo
on August 11, and the second Commissioner, Mr. Brookes, reported on
August 27. I endeavoured to help them in every way that was possible,
and finally asked to be relieved of the work on September 9, expressing
my willingness, however, to continue to aid in any way they desired. My
relationship to them has been cordial, and I am very glad if I have been
able to be of any assistance.
I now propose to deal with the operations of the Society under various
headings:
1. _Finance._--The original fund in the hands of Surgeon-General
Williams was operated upon by him in London, in Malta, and in Egypt. It
was only in Egypt that I was concerned with it, and to a limited extent.
It was most helpful, and great service was rendered during the crisis by
the prompt distribution of money.
When the General Committee, of which His Excellency Sir Henry MacMahon
is President, was formed, separate funds were forwarded to him in
response to a cable from me indicating that more money was wanted. I
suggested the supply of another £10,000, but when, on July 9, £18,000
had been received it became obvious that operations were contemplated on
a more extensive scale than had hitherto been thought necessary. I have
prepared a summary of the amounts distributed to medical units from both
funds, and given an account of the method adopted.
The Red Cross Society originally intended that £10,000 was to be
expended by the officers commanding medical units, and General Williams
embodied the direction in the following circular, to which I
subsequently added a memorandum in further explanation of new conditions
which had arisen.
[Illustration: INTERIOR OF RED CROSS STORE: UTILISATION OF CASES FOR
SHELVING.
_To face page_ 144]]
_Australian Imperial Force_
Received from Surgeon-General W. D. C. Williams, Director Medical
Service, A.I.F., the sum of ---------------- stg. to be utilised and
accounted for by me in terms of Circular Letter No. E 1/15, dated
13-2-15.
---------------- O.C.
_Place_ ----------------
_Date_ ----------------
_Australian Imperial Force_
Circular Letter No. E 1/15.
O.C.,
1. Forwarded herewith the sum of ---------------- stg. to be expended by
your authority and direction on such articles as you may consider
requisite for the general improvement of equipment, stores, or other
items which in your opinion will conduce to the general well-being and
comfort of the patients in hospital under your command.
2. Attached receipt forms to be signed in duplicate and returned to me.
3. When three-fourths of the amount allocated to you has been expended,
you will furnish this office with expenditure vouchers in duplicate.
This will enable me to keep the High Commissioner informed as to how the
moneys are being spent, and to arrange for further grants if considered
necessary.
SURGEON-GENERAL,
_Director Medical Services, A.I.F._
[_Copy_]
_May 20, 1915._
O.C.
Govt. Hospt.
Tanta, Damanhour and Shebin el Kom.
1. I enclose herewith cheque for {£50 £25 £25} to be expended in terms
of the Circular Letter attached. Will you please sign the accompanying
receipt in duplicate and oblige.
2. It is not desired that the expenditure of the money should be
restricted to Australians, as such a course would, I think, in a
hospital be impracticable and undesirable. If, however, this is used for
all the Allied troops under your care, then the next instalment which
may become necessary might well be provided from the "Military Hospitals
Fund" or the "Egyptian Red Cross Fund."
3. I shall be glad if you will communicate to the men in the Hospital
the fact that comforts are being supplied from the Fund of the British
Red Cross Society (Australian Branch), the administration of which fund
is in the hands of Surgeon-General W. D. C. Williams, C.B.
(_Signed_)
JAMES W. BARRETT,
_Major_,
for W. D. C. WILLIAMS,
_Surgeon-General_.
GRANTS OF MONEY MADE TO VARIOUS HOSPITALS FROM RED CROSS FUNDS
Hospital or Medical Unit, etc. Amount in
Egyptian
pounds.
First Australian General Hospital and
Auxiliaries 1376,42.5
Second Australian General Hospital 682,50
Share of Rent of Luna Park for three
months 117,00
Y.M.C.A. (including stationery, building
fund, Soldiers' Café, and sundry accounts) 982,08.6
Venereal Hospital, Abbassia 48,75
Deaconess Hospital, Alexandria 78,00
European Hospital, Alexandria 48,75
Government Hospital, Tanta 53,62.5
No. 21 General Hospital, Alexandria 97,50
Convalescent Home, Al Hayat, Helouan 341,25
Convalescent Home, Ras el Tin, Alexandria 97,50
A.D.M.S., First Australian Division 292,50
First Stationary Hospital 195,00
Second Australian Stationary Hospital 196,24.7
First Casualty Clearing Station 146,25
Fourth Field Ambulance 290,00.2
First Light Horse Field Ambulance 97,50
Second Light Horse Field Ambulance 195,00
Third Light Horse Field Ambulance 48,75
Fifth General Hospital 97,50
Fifteenth Stationary Hospital 97,50
17th General Hospital 146,25
Bombay Presidency Hospital 58,50
Government Hospital, Alexandria 48,75
Convalescent Camp, Mustapha 48,75
Government Hospital, Damanhour 24,37.5
Government Hospital, Shebin el Kom 34,12.5
5th Indian General Hospital, Alexandria 48,75
Government Hospital, Benha 5,00
Greek Hospital, Alexandria 29,25
Government Hospital, Suez 24,37.5
Red Cross Depot, Suez 48,75
Ras el Tin Hospital, Alexandria 195,00
15th General Hospital, Alexandria 48,75
----------
£E.6340,26
The Egyptian pound is to the British pound sterling as 100:97·5.
In addition, a considerable amount of money had been spent in other
countries. There was, however, no knowledge in Egypt of the sum which
would be ultimately available. Furthermore, in the absence of
instructions from Australia, no serious departure had been made from the
policy originally laid down. In fact I am doubtful to a degree whether
any Red Cross movement should in normal conditions go beyond the
successful policy adopted.
2. _Red Cross Store._--Goods received were passed into the Red Cross
store, the contents of the cases ascertained as far as possible, and
entered in books kept for that purpose. They were issued on requisition
signed by the Officer Commanding any medical unit. Corresponding entry
was made in the book of issue, and the difference between the stock
received and that issued from day to day was shown in the form of a
stock sheet. Stock-taking was effected from time to time.
[Illustration: RED CROSS BASE DEPOT, HELIOPOLIS.
_To face page 148_]]
The store was staffed at first by two nurses and three orderlies, later
it was staffed by a sergeant and six or seven orderlies who were
approved by the military authorities. The staff therefore consisted of
myself, with my own clerical staff, the orderly officer of the hospital,
Captain Max Yuille (latterly Captain Dunn), the sergeant and seven
orderlies, together with extra helpers at times. The store was connected
by telephone with the hospital, and every effort made, compatible with
the excessive demands on the time of all, to manage it in a methodical
manner.
3. _Receipt of Goods._--The receipt of goods has, owing to the
peculiarities of Egypt and the circumstances of the war, given a good
deal of trouble, and I am making it the subject of a separate
memorandum. It may suffice here to say that it will never be
satisfactory until the Red Cross Society in Australia cables, when the
ship leaves Fremantle, precisely the number of packages on board, the
port of destination, and the probable time of arrival of the ship; and
also accurately informs the officers commanding the ship of the nature
of the Red Cross goods on board. In this connection it may be
interesting to note the following letter from Colonel Onslow, who has
just arrived by the _Runic_ in Egypt, and who, but for the printed
instructions drawn up by me and conveyed to him at Suez, would not have
known that any Red Cross goods were on board:
CONTINENTAL HOTEL, CAIRO,
_September 13, 1915_.
LIEUT.-COLONEL BARRETT,
A.A.M.C.
MY DEAR SIR,
You will remember that on Saturday last you asked me to write to you
regarding the Red Cross Stores on the Transport A 54 _Runic_ of which I
was in military command.
When I took command on August 9 in Sydney I had no information as to
there being any Red Cross Stores on board except that one of the ladies
of the Red Cross Committee had told me that a few stores were to be put
on board and would be at my disposal if needed for the troops under my
command.
Subsequently I saw some half a dozen cases which I assumed to be those
to which she had alluded.
On arrival at Suez, September 9, the printed instructions as to disposal
of Red Cross Stores were handed to me. This caused me to make inquiries.
The ship's purser knew nothing of any such stores and they were not
shown in the manifest.
But from the Chief Officer I learned that a large number of which he had
an incomplete list had been placed in one of the holds. It was even then
too late for me to ascertain their number or nature, as I was in the
midst of disembarking returning ship stores, etc. They were therefore
landed without the required list.
But if either a wireless had been sent to me a day or two beforehand, or
if the persons responsible for shipping had informed me in Sydney, there
would have been no difficulty whatever. Under the lack of system which
would seem to prevail in shipping these stores from Australia it would
not be surprising if they were overcarried and lost.
Yours faithfully,
(_Signed_) J. MACARTHUR ONSLOW,
_Colonel_.
I publish this letter simply to show the difficulties and to indicate
the magnitude of the task. I do not think any one is to blame, but
rectification is wanted. A huge commercial concern has gradually grown
up and now requires firm paid commercial management. The Australian Red
Cross has become a gigantic Commercial Institution with attendant
advantages and disadvantages.
It should be remembered that goods are shipped in Australia from at
least six different ports separated by distances of hundreds of miles,
that nearly the whole of the work has been amateur, and that it is
difficult to inaugurate a proper business system rapidly.
The following are the printed directions referred to by Colonel Onslow:
HEADQUARTERS, CAIRO.
_From_ A.D.M.S., Australian Force,
Headquarters, Cairo.
_To_ O.C. Troopship----
1. Will you please instruct a Medical Officer to make a list in
duplicate of the surplus medical stores and Red Cross goods, including
ambulances, on the ship. He will hand one list to the representative of
Australian Intermediate Base (Captain Clayton) and retain the other.
2. Will you please detail a Medical Officer, or if that be impossible
another Commissioned Officer, who will see that these goods are put on
the train, and travel with them to their point of destination.
3. At the place of destination he will hand them over with an inventory
to a representative of A.D.M.S. Australian Force (Lieut.-Colonel
Barrett), from whom he will obtain a receipt. He will not, under any
circumstances, hand them over to any one else, or take any verbal
receipt.
4. If it be impossible to send the goods by passenger train they may
proceed by goods train, in which case an N.C.O. or orderly must be
detailed to travel in the brake van; and deliver the goods to a
representative of A.D.M.S. Australian Force (Lieut.-Colonel Barrett) in
precisely the same way.
5. You will please detail a fatigue party of sufficient strength for
unloading the goods from the transport and placing them on the train,
and in addition supply any guard that is necessary to protect them until
this work is completed.
6. It is undesirable in any circumstances to send goods by troop train.
It is much better to send them by goods train.
7. Will you please convey these orders in writing to the Medical Officer
or Officer concerned. If any conflicting orders be issued he can then
produce this authority.
A.D.M.S. AUSTRALIAN FORCE.
4. _Distribution of Goods._--The distribution of goods was effected on
requisition signed by the O.C. of the medical unit requiring them,
transport was provided by the Red Cross Society to the railway station
(usually by motor lorries) and at public expense on the railways. I soon
learnt that in Egypt in time of war there is no certainty of the
delivery of the goods to the proper quarter unless some one is sent with
them. The railway officials will frequently hand over goods to a
military officer without obtaining a receipt. Accordingly one or more
orderlies were sent with every train conveying Red Cross goods. They
handed the goods to the consignee and brought back the receipt.
In the Australian hospitals the distribution of goods was effected by
two methods. Anything wanted from the central store could be obtained by
requisition signed by the O.C. of the hospital, and countersigned by
myself as Red Cross officer. Very large quantities of goods were thus
transferred from the central store to the quartermaster's department.
They were then issued in the ordinary way by requisition of the sisters
or medical officers, and those receiving them were not aware whether
they were receiving Red Cross goods or Ordnance goods. The system had
the merit of extreme simplicity, and was very speedy in its operation.
It certainly seemed at the time far less important that patients should
know where the goods came from than that they should obtain them
promptly. Later on the expediency of putting a Red Cross label on
everything supplied became obvious and was adopted as a policy.
5. _Scope of Operations._--At first the operations of the Society were
confined to Egypt, but soon, in conjunction with the British Red Cross,
goods were forwarded to the Dardanelles and elsewhere. The tables show
the quantity of goods sent to transports in the Mediterranean and
transports leaving for Australia. No request was ever refused. When
dispatching goods to the Dardanelles it was considered better to act,
as far as possible, through the British Red Cross Society.
On July 5 I wrote to General Birdwood, Commanding Officer A. and N.Z.
Army Corps, asking him whether I could establish a Red Cross store at
Anzac. He replied that it was impossible, but at his suggestion a Red
Cross store at Mudros in the island of Lemnos was organised in
conjunction with the British Red Cross Society. The Army Medical Corps
at Anzac was then advised to requisition on Mudros. The difficulties,
however, of landing goods at Mudros were very great--so great that the
British Red Cross Society was compelled to buy launches and lighters.
The Australian Red Cross Commissioners are about to supplement the
purchase. The tables show the quantity and character of the goods sent
forward in spite of many difficulties. It was often necessary to send an
orderly in the hospital ship to Mudros and Anzac to ensure delivery.
6. _Other Activities._--The British Red Cross Australian Branch arranged
through the Y.M.C.A. for the free distribution of stationery to the
soldiers in hospitals in Egypt. With the assistance of the Y.M.C.A. and
some English ladies in Cairo a number of committees were formed to
entertain the sick and wounded in various ways. A cinema was purchased,
a small orchestra was engaged to visit the hospitals, bands of ladies
agreed to take flowers and the like to the hospitals, and everything was
done that could be done to render the tedium of convalescence less
objectionable.
Large recreation huts were built at many of the hospitals at the expense
of the Australian Branch.
This phase of the work should not be passed over without the most
handsome acknowledgment to the English ladies in Cairo. These
public-spirited ladies, headed by Mrs. Elgood, thoroughly organised what
I may call the lighter side of hospital work, and not only by their
personal attention, but also by their tactful skill, succeeded in making
the conditions of the sick and wounded much more comfortable.
Furthermore although we left Australia knowing that the Y.M.C.A. did
good work in camps, yet the practical experience of the Y.M.C.A. work in
Egypt has left an indelible impression on our minds. Headed by Mr.
Jessop, their secretary, there was no service in connection with the
sick and wounded which they failed to render when provided with the
proper means. We felt the utmost confidence in entrusting them with any
undertaking, provided that the position was clearly defined and provided
that they were not hampered in their activities.
In passing it may be said that until June 15 the shortage of nurses and
medical officers was considerable. Of lay helpers there were few in
Cairo during the summer, and the principle was invariably adopted of
using all existing agencies to cover the ground, the necessary support
being given by the Red Cross Society. It was on this principle that Mrs.
Elgood acted, it was on this principle that the Y.M.C.A. acted, and it
is on this principle that all great organisations can be most
successfully conducted. If it had become necessary to create an
independent organisation to provide cinemas and bands, to disburse
stationery in Egypt and at the Dardanelles, distribute flowers, fruit,
games, etc., a very large number of soldiers would have been employed
who were much better employed otherwise. Furthermore, they would not
have done the work as well as Mrs. Elgood's staff or the Y.M.C.A.
7. _Issue of Purchased Goods._--As the fund grew in volume it was
decided to spend some of it in the purchase of articles desired by the
men. A vote was taken at No. 1 Auxiliary Convalescent Depot (Luna Park)
to ascertain the articles the men most desired--see appendix. Boxes
containing a number of articles were issued to every patient on
admission. This has involved an expenditure rising to £500 per month. A
sample box has already been sent to Australia. In each box the following
note was placed:
"The object of the Australian Red Cross Society is to provide comfort
and help to the wounded and sick soldiers, such as hospital clothing,
invalid comforts, tobacco, toilet necessaries, books, magazines,
newspapers, and the like, and also recreation huts for entertainment,
etc.
"These comforts are supplied over and above the hospital necessaries
which the Commonwealth of Australia furnishes on so liberal a scale.
"The Society hopes that your stay in the hospital will be short and
pleasant, and that your convalescence will be rapid so that you can
speedily serve your country again. The Society asks you to accept the
contents of this box as an indication of Australia's desire to help
you."
8. _Convalescent Home at Montazah._--The Montazah palace, which was
owned by the late Khedive, was offered to Lady Graham by H.H. the Sultan
as a Convalescent Home for soldiers. The British Red Cross Society and
the Australian Branch combined and agreed to find £3,500 to equip it.
This beautiful hospital consists of a number of buildings situated on
the shore of the Mediterranean, with artificial harbours and provision
for bathing, fishing, and boating. It is now in excellent order and is
most successful.
While I think it was right to take a share in the erection of this
convalescent home, which indeed could not have been obtained as a
military hospital, it immediately raised in mind the consideration of
the propriety of the Red Cross conducting hospitals in any
circumstances. It is of course the English practice, and the special
circumstances of Great Britain may make it necessary to erect Red Cross
hospitals. The Commonwealth of Australia has never prevented the
establishment of as many hospitals as may be considered necessary in the
field. In my judgment it is better to limit the conduct of military
hospitals and convalescent hospitals to official authority, leaving the
Red Cross to supplement the work in the way already indicated. Otherwise
the Red Cross is simply doing Governmental work. The Red Cross may do
the work very well indeed, but the advantage is not obvious.
9. _Motor Transport._--The motor ambulances presented by the Australian
Branch have been housed in two garages, one at Heliopolis and the other
at Gezira. They were both designed by Surgeon-General Williams and
provided from Red Cross Funds. It is not too much to say that the
organisation of the motor transport assisted materially in saving the
position. For a long time, with the exception of some New Zealand
ambulances, there were no other ambulances in Egypt. At Heliopolis a
repairing plant was installed at Red Cross expense in order to reduce
the cost of repairs.
There is no doubt that the British Red Cross Australian Branch was at
the outset of exceptional service because it possessed on the spot
stores, money, and motor transport.
10. _Bureau of Inquiry._--The British Red Cross Society instituted a
bureau of inquiry in order to obtain supplemental information about the
sick and wounded. Inquiries on an elaborate scale are made at the office
of the Commonwealth Government, but certain supplementary and private
inquiries can be made with profit. The British Red Cross Society was
requested to undertake such inquiries and to charge Australian Red Cross
for the extra assistance necessitated.
11. _Hospital Trains._--At an early stage steps were taken to equip
hospital trains running from Alexandria to Cairo with everything the
officers in charge required.
Furthermore, arrangements were made at Red Cross expense to provide a
restaurant car on all trains conveying sick and wounded to Suez. For
detailed arrangements see page 166. This arrangement has proved of great
benefit. The men obtained free lime juice and water and their rations.
They could purchase in addition comforts at bed-rock prices. The
innovation may seem a small one, but it was not effected without
considerable trouble owing to shortage of rolling stock.
LIST OF RED CROSS GOODS ISSUED TO UNITS FROM END OF MARCH TO
SEPTEMBER 3, 1915
_Prepared by Staff-Sergeant Hudson_
Unit. Articles. Cases. Pkgs.
First Australian General Hospital 76,350 462 39
No. 1 Auxiliary Convalescent Depot 3,377 22
No. 2 Auxiliary Convalescent Depot 11,340 78 7
No. 3 Auxiliary Convalescent Depot 6,393 74 13
Infectious Diseases Hospital, Choubra 6,303 7
Ras el Tin Convalescent Home 19,562 65 8
Al Hayat Convalescent Home 36,050 92 2
No. 2 Australian General Hospital, Ghezira 25,437 75 4
Mena Australian Hospital 2,705 4 2
Venereal Diseases Hospital, Abbassia 7,626 22 2
Hospital ships and transports 46,350 19
Imbros Rest Camp Hospital 650 70
Kasr el Aini 13,372 11
Greek Hospital, Alexandria 1,381
Colonel Bryant, Lemnos 23,236 127 8 sacks
4th Field Ambulance, Dardanelles 8,472 2
1st Stationary Hospital, Lemnos 42,333 107 12 sacks
2nd Stationary Hospital, Lemnos 187 107 13 sacks
7th Field Ambulance, Polygon Camp, Cairo 4 2
2nd Light Horse Field Ambulance,
Maadi, Cairo 6,056 2
2nd Light Horse, Lemnos 7,985 2
Captain Dunlop, 18th Battalion 37
Captain Williams, Hqrs. 2nd Austr. Division 30
No. 4 Auxiliary Convalescent Depot 754
Heliopolis Dairy Company for 1st A.G.H. 800
Zeitoun Convalescent Camp 2,250 13
6th Light Horse 560
Dr. Hastings 500
No. 17 General Hospital, Alexandria 3,532
Deaconess Hospital, Alexandria 1,733 6
Egyptian Army Hospital, Abbassia 708 6
2nd Indian General Hospital 6,486
Dr. Oulton, Tanta Hospital 3,899
Mustapha Barracks, Alexandria 4,585
New Zealand Mounted Rifles 736 1
Lancashire Fusiliers 1,116
No. 15 General Hospital, Alexandria 4,199
Military Hospital, Cairo 244 1
School Hospital, Port Said 700
Red Cross Hospital, Saideh School 3,456 2
No. 4 Base, Medical Depot, Alexandria 13,032
Convalescent Hospital, Ismailia 1,904
French Convalescent Hospital, Alexandria 2,294
Ordnance Office Base, Alexandria 9,528
European Hospital, Alexandria 740
4th Field Ambulance 1,250
------- ----- ---
Total 411,974 1,357 110
======= ===== ===
LIST OF RED CROSS GOODS SUPPLIED FROM STORE APART FROM OTHER GOODS
PURCHASED AND SUPPLIED
Aprons (surgical) 260
Blankets 5,875
Cholera belts 7,400
Hot-water bottles 407
Bandages 51 cases
" 200
Books 87 pkgs.
Caps 2,010
Caps (surgical) 266
Dressing-gowns 184
Handkerchiefs 46,298
Housewives 776
Cardigan jackets 3,483
Hospital jackets 269
Pneumonia jackets 341
Old linen 90 cases
Mufflers 3,662
Masks (surgical) 24
Nightingales 495
Overalls (surgeons') 243
Pillows 2,945
Pillowslips 24,501
Pyjamas 17,300
Pyjama trousers 881
Pipes 1,570
Quilts 43
Sheets 7,240
Draw sheets 4,032
Shirts (flannel) 24,876
Shirts (cotton) 9,913
Hospital shirts 4,725
Socks 70,725
Bed socks 1,018
Toilet soap 2,789 cakes
" " 4 cases
Slippers 5,878
Towels 43,914
Medical towels 4,183
Undershirts (flannel) 12,333
Underpants (flannel) 5,588
Vaseline 284
Face washers 37,665
Binders 200
Hospital bags 334
Soldiers' kit bags 4,710
Air cushions 17
Tooth brushes 6,885
Tooth paste 1,552
Sea kit bags 717
Hair brushes 1,047
Hair combs 1,081
Ointment 208
Playing cards 723
Pencils 176
Safety pins 380
Rubber sheets 6
Mosquito nets 1,251
Insect powder 314 pkts.
Sponges 2,756
Tobacco 2,379 plugs
" 16 cases
Cigarettes 3,741 pkts.
" 1 case
Biscuits 64 cases
Extract of beef 45 "
Soap 1,120 bars
" 70 cases
Gooseberries 66 "
Glaxo 38 "
Milk 36 "
Beans 20 sacks
Peas 13 "
Jam 172 cases
Syrup 54 "
Tomatoes 51 cases
Milk and cocoa 5 "
" " 69 tins
Pineapples 98 cases
Apricots 49 "
Honey 8 "
Dried apples 47 "
Dried peaches 115 "
Pears 43 "
Foodstuffs 77 "
" 55 pots
Malted milk 6 cases
Chocolate and sweets 2 "
" " 634 "
Extract of malt 3 "
Rolled oats 1 case
Lactogen 7 cases
Ground sheets 22
Cloth caps 2,984
Games 65
Walking-sticks 16 bundles
" 687 loose
Writing-pads 1,206
Envelopes 28,470 pkts.
Lemons 15 cases
Glass towels 325
Sun glasses 108
Hot-water bottle covers 260
Dusters 773
Mattresses 9
Swabs 7 cases
" 500
Candles 1 case
Cane chairs 70
Toilet paper 45 cases
Puddings 1 case
Preserved fruit 47 cases
Linen coats 388
Cushions 115
" 3 cases
Fly whisks 725
" 2 cases
Knives 30
Spoons 95
Wine 8 cases
Deck chairs and camp stools 340
Bales of clothing 25
Brassards 200
Shaving-brushes 1,801
Skin coats 10
Cotton thread 50 reels
Toilet paper 100
Nail brushes 24
Jug covers 100
Mittens 673
GOODS SENT TO LEMNOS
Articles. Cases. Sack.
1st Stationary Hospital, Lemnos 42,333 107 12
2nd " " " 187 107 13
Imbros Rest Camp 650 70
Col. Bryant, for Distribution, Dardanelles 23,236 127 8
2nd Light Horse, Lemnos 7,985 2
AGREEMENT MADE FOR PROVISION OF REFRESHMENTS TO SOLDIERS ON INVALID
TRAINS
1. The Restaurant Car can be placed on the train and the cost of same,
£7 10s., guaranteed by Lieut. Colonel Barrett.
2. Meals will be provided for Commissioned Officers, P.T. 20 lunch or
dinner, P.T. 5 afternoon tea, at stated times.
3. Meals and afternoon tea will be provided for N.C.O.s in the
Restaurant Car at half price.
4. Sandwiches, P.T. 1, and non-alcoholic drinks (soda water, lemonade,
etc.), P.T. 1, will be served in the cars by the attendants of the
Restaurant Car to soldiers who desire to purchase them.
5. In addition, water will be provided in each carriage for the use of
soldiers in fantasses, and lime juice will be supplied, two bottles in
each carriage, free.
Notice to this effect will be posted in every carriage on the troop
train.
_July 1, 1915._
[Illustration: HELIOPOLIS SIDING: ARRIVAL OF WOUNDED.
_To face page 166_]]
12. _Soldiers' Clubs._--Reference has been made in the chapter on
Venereal Diseases to the damage done to Australian troops in Egypt by
venereal disease. Reference has also been made to the establishment of
soldiers' clubs and recreation huts in various places to provide a
counter-attraction to those entertainments furnished by the prostitute
and her degraded male attendants. After the various repressive steps
already referred to had been taken, an earnest attempt was made to
organise this constructive work. The valuable assistance of Mr. Jessop
and the Y.M.C.A. was again invited. The Y.M.C.A. proposed to build in
Alexandria on the sea front a large building to be used as a central
soldiers' club, and to be available for convalescents and the healthy.
The Y.M.C.A. had only £250 available and required £1,000. The British
Red Cross Society was appealed to and hesitated. A cable was dispatched
to London, and an expenditure of £250 authorised. Surgeon-General
Williams, after consultation with His Excellency Sir Henry MacMahon, the
G.O.C.-in-Chief, Sir John Maxwell, and the D.M.S. Egypt, General Ford,
decided to make a grant of £500 in addition for the purpose. The club
was opened on September 12, and from its opening was a pronounced
success. The soldier on leave, tramping about the streets of Alexandria,
gets leg-weary and falls an easy victim to the wiles of the various
agents abroad. He now can visit his own club, where the entry is free to
all men in uniform. He there receives war telegrams, stationery, cheap
and excellent meals, and enjoys various forms of entertainment. He meets
his friends, and can spend the time under the most pleasant conditions.
The building already requires extension, as the pressure on the
accommodation is so great. Similar action was taken in Cairo, where
after many unsuccessful attempts the Rink Theatre in the beautiful
Esbekieh gardens was obtained, owing to the sympathetic help given by
His Excellency Sir Henry MacMahon and other authorities. This open-air
theatre is a little over an acre in extent, and is a valuable property.
It had been leased to a restaurant keeper in the vicinity. Arrangements
were made for the supply of light refreshments at bed-rock prices in the
theatre, and other meals at low prices at the restaurant which is about
fifty yards away. In addition a soldiers' club, managed by ladies, is
equidistant, and at this comfortable resort refreshments are supplied in
quiet rooms at low rates. Naturally the club has become a resort for all
the soldiers in Cairo. Major Harvey, Commissioner of Police, has cleared
the surrounding gardens of undesirable characters. The club was placed
under the management of a joint committee of which Her Excellency Lady
MacMahon is Patroness, and Lady Maxwell is President. The executive
committee consists of three members of the Y.M.C.A., and the expenses of
managing the club were provided by the British Red Cross Society,
Australian Branch, for the first three months. It was soon found that in
order to make the club successful the athletic element must be
developed, and splendid programmes were arranged--boxing, fencing,
skating contests, and the like. The club provides writing-paper, games,
war telegrams, Australian and other newspapers, shower baths, and other
conveniences. As many as 1,500 soldiers are present on some of these
occasions, and the club is visited by officers who periodically drop in
amongst the men. Altogether the success has exceeded even the sanguine
expectations of those who founded it.
The British Red Cross Society, Australian Branch, was most fortunate in
securing such a site, as any one acquainted with the conditions of Cairo
is fully aware.
[Illustration: MATRONS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL.
_To face page 169_]]
The exact extent to which these clubs have contributed to the limitation
of venereal disease cannot be accurately measured, but there is no doubt
whatever in the minds of any one acquainted with the facts respecting
their salutary and healthy influence. Under the new constitution of the
Australian Red Cross money cannot be devoted to their maintenance,
because it is not being used exclusively for the sick and wounded. Such
is the ruling, although many convalescents use the clubs. It is
regrettable that such a rigid ruling should have been established. It is
absurd to permit men to become infected and then to assist them by doles
of chocolate and tobacco, and yet to refuse to provide the necessary
funds which assist so materially in preventing infection.
13. _Nurses' Rest Homes._--The nurses in the hospitals had done
excellent work under trying conditions, and it became obvious that many
of them would break down unless holidays and rest were provided.
The British and Australian Red Cross Branches combined under the
Presidency of Her Excellency Lady MacMahon, and opened two rest
homes--one in Ramleh near the beach, and the other at Aboukir Bay, the
site of Nelson's victory.
They were furnished by the Red Cross Societies and have been maintained
by the Commonwealth Government so far as the Australian nurses are
concerned. They have met a great want and have proved a boon and a
blessing.
_Conclusion._--The work has been very heavy and the circumstances far
from easy. Taking everything into consideration and realising the
pressure at both ends, the result can only be regarded as more than
satisfactory. The policy of the Red Cross Society requires, however,
some consideration.
The policy adopted until lately was that reasonable intimation should be
given to the Red Cross Society of the requirements of those who want
help. Under public pressure another policy may make its
appearance--that of compelling the Red Cross Society to find out what
people want. A word of caution is necessary. This policy will almost
certainly result in the creation of an extensive business organisation
and in the Red Cross undertaking much work which the Government should
do. In my opinion the Red Cross Society is entirely ancillary, its
functions being to provide comforts and other things which the
Government cannot supply, and to act decisively at critical moments. It
should, however, refrain from embarking on great national undertakings.
Every one will endeavour to help the Commissioners in their extensive
and difficult task, and will look forward to the Australian Red Cross
maintaining the high reputation which it has already gained amongst
responsible officers in Egypt.
In conclusion it should be pointed out that during the whole period
under review all necessary services were provided by the military
authorities and the Red Cross was administered on military principles.
Consequently there were no large expenses, no one received any money in
payment for services, and the storage of goods was free.
If the Red Cross is to be administered on non-military lines many
charges must be properly made and met, but the efficiency of the system
instituted and now set aside must be judged largely from the standpoint
of economic administration.
JAMES W. BARRETT,
_Lieut.-Colonel_.
(In this volume the original report forwarded to Melbourne has been
expanded and amplified.)
APPENDIXES
1. _Directions for the Conduct of the Red Cross Depot_
Depot--conduct of. 1. The Depot is placed under
the charge of a Medical
Officer who will have at
his disposal nurses and
orderlies in such numbers
as the work from time to
time may necessitate.
Storage of goods. 2. All goods consigned to the
Red Cross Depot shall be
placed in store at once
and rendered secure under
lock and key at other
than business hours.
Receipt Book. 3. All goods received will be
entered in the Goods Receipt
Book.
Requisitions--how 4. On receipt of requisitions
dealt with. signed by the Officer Commanding
any unit, and
countersigned by the
Officer Commanding
First Australian General
Hospital, goods will be
issued, and if necessary
transport provided. Two
clear lists shall be prepared
on forms provided
for the purpose, one to be
receipted and returned to
Red Cross Depot by the
consignee and duplicate
to be filed in Office.
Stock-taking. 5. A Stock Book is to be kept
showing the nature and
quantity of material received,
and the quantity
distributed, so that at
any time the stock remaining
can be ascertained.
This book to be
checked once a month by
stock-taking of the contents
of the store and
certified to by the M.O.
in charge.
2. _Result of Vote at No. 1 Auxiliary Convalescent Depot_
The following items represent the wishes of 840 patients at Luna Park on
July 29, 1915, ascertained by the O.C., Major Brown.
Four hundred and forty papers were received, a great number of patients
failing to vote.
The patients were asked to make a list of twenty to thirty articles that
would add to their comfort during their stay in hospital, and which
could be supplied by a small fund at his disposal.
The average items on collected lists were 8.
Razors 249
Shaving-sticks 244
Razor strops 241
Toothpaste 221
Cigarette 194
Toilet soap 188
Matches 170
Mirrors 177
Shaving-brushes 163
Tooth-brushes 148
Handkerchiefs 131
Tobacco 121
Pipes 106
Hairbrushes 99
Writing material 98
Haircombs 96
Fruit 63
Chocolate 54
Socks 37
Sweets 32
Pocket knives 30
Playing cards 21
Lead pencils 19
Housewives 14
Cigars 11
Biscuits 10
Walking-sticks 8
Shirts 8
Singlets 7
Belts 6
Tobacco pouches 4
Fountain pens 3
Bottles of ink 3
Nail brushes 3
Boot laces 3
Post cards 3
Mouth organs 3
Cigarette holder 1
Cigarette lighter 1
" papers 1
Sponge 1
Pair scissors 1
Soap box 1
Nuts 1
Dark eye-glasses 1 pair
Blades for safety razors 1 set
Notebook 1
3. _Fence or Ambulance?_
Some critics have objected to the Red Cross assisting Soldiers' Clubs.
The following lines are commended to their notice. But for the
Australian Branch British Red Cross there would have been no such
Soldiers' Clubs as those provided at Esbekieh and Alexandria.
[Illustration: SOLDIERS' CLUB, ESBEKIEH, CAIRO.
_To face page 174_]]
'Twas a dangerous cliff, as they freely confessed,
Though to walk near its crest was so pleasant;
But over its terrible edge there had slipped
A duke, and full many a peasant.
So the people said something would have to be done,
But their projects did not at all tally:
Some said, "Put a fence round the edge of the cliff";
Some, "an ambulance down in the valley."
But the cry for the ambulance carried the day,
For it spread through the neighbouring city,
A fence may be useful or not, it is true,
But each heart became brimful of pity
For those who had slipped over that dangerous cliff;
And the dwellers in highway and alley
Gave pounds or gave pence, not to put up a fence,
But an ambulance down in the valley.
"For the cliff is all right if you're careful," they said,
"And if folks even slip and are dropping,
It isn't the slipping that hurts them so much
As the shock down below when they're stopping."
So day after day, as those mishaps occurred,
Quick forth would these rescuers sally
To pick up the victims who fell off the cliff,
With the ambulance down in the valley.
Then an old sage remarked, "It's a marvel to me
That people give far more attention
To repairing results than to stopping the cause
When they'd much better aim at prevention.
Let us stop at its source all this mischief," cried he,
"Come, neighbours and friends, let us rally!
If the cliff we will fence we might almost dispense
With the ambulance down in the valley."
"Oh, he's a fanatic," the others rejoined.
"Dispense with the ambulance? Never!
He'd dispense with all charities, too, if he could!
No, no! We'll support them for ever!
Aren't we picking folks up just as fast as they fall?
And shall this man dictate to us? Shall he?
Why should people of sense stop to put up a fence
While their ambulance works in the valley?"
But a sensible few, who are practical too,
Will not bear with such nonsense much longer;
They believe that prevention is better than cure,
And their party will soon be the stronger.
Encourage them, then, with your purse, voice, and pen,
And (while other philanthropists dally)
They will scorn all pretence, and put a stout fence
On the cliff that hangs over the valley.
Better guide well the young than reclaim them when old,
For the voice of true wisdom is calling:
"To rescue the fallen is good, but 'tis best
To prevent other people from falling.
Better close up the course of temptation and crime
Than deliver from dungeon or galley;
Better put a strong fence round the top of the cliff,
Than an ambulance down in the valley."
JOSEPH MALINES.
THE RED CROSS POLICY: WANTED, A DEFINITION
Before leaving consideration of the details of the Red Cross question,
attention should be directed to the numerous changes in the policy
adopted by the British Red Cross Society, Australian Branch. No less
than three different types of administration were rapidly adopted. It
was first placed in the hands of Surgeon-General Williams and the High
Commissioner for Australia, in London; then it was placed under a
committee in Egypt formed by the High Commissioner for Egypt, Sir Henry
MacMahon, and six weeks later two Commissioners were appointed to take
the work over. Nothing more clearly illustrates the state of mental
instability in which a first experience of war had thrown the population
of Australia. The policy which was adopted by Surgeon-General Williams
in connection with the Red Cross administration is that which we believe
to be sound.
When acting as A.D.M.S. to the Australian Force in Egypt it became my
duty (Lieut.-Col. Barrett) to sanction or modify the requisitions of
medical stores for the various hospitals and units, and the instructions
conveyed to me were that I could sanction any requisition provided that
it was reasonable. If, however, it represented a new departure it must
be authorised by the D.M.S. Egypt. This meant practically that
everything could be obtained from Ordnance, and many of the Red Cross
supplies became superfluous. That is to say, any necessary goods in the
Red Cross store were utilised, but if they had not been there the
Government would have purchased them. In fact, it reduced the field in
which the Red Cross could operate to comparatively small proportions.
There is no doubt that, had it become necessary, I should have
authorised the erection of shelter sheds and recreation huts in the
various hospitals as a medical necessity. There was one advantage, and
one advantage alone, in effecting these changes with the aid of the Red
Cross. The action if sanctioned by superior officers could not be
challenged by any one else at the time, and could be effected with
extraordinary speed.
I took the view that it was the business of the Officer Commanding the
hospital, with the aid of the matron, sisters, and medical officers, to
let me know what was thought necessary, and unless the requirement was
outrageous it was immediately supplied. As a matter of fact no single
request for money or goods was ever refused or seriously modified. Owing
to pressure of public criticism another policy began to make its
appearance. It was asserted that it was the duty of the Red Cross
officer to visit the various hospitals to find out what the patients
ought to receive. It will be seen that such a policy removed from the
O.C.s of the hospitals, or any one to whom they may have delegated their
powers, the responsibility for determining what patients should receive.
Such a policy sooner or later must result in the creation of an army of
people who are worrying to find out what they can do instead of being
properly instructed by those responsible for the welfare of the
patients.
It further tended to place in the hands of irresponsible people some
control over the medical management of hospital cases. If lay visitors
can enter a hospital and provide food for patients, they may next wish
to provide drugs, etc. It seemed that the policy laid down in the first
instance was sound, useful, and healthy.
When the Commissioners took office they made a number of changes in
detail. They shifted the position of the store; they printed different
forms of requisition, and they took the goods out of the quartermaster's
store and placed them in a store in the hospital, presided over by a
volunteer. The goods were then obtained by requisition from the sisters
and the matron. But as the President of the Red Cross Inquiry Court
pointed out, with one trifling exception the method was not really
altered. The control had simply ceased to be military, and had become
civil. Consequently a large staff of capable people were withdrawn from
their ordinary occupations in Australia, and devoted themselves to an
administration which had been hitherto effected entirely by the
soldiers. We do not think that the change was right or desirable. It
resulted in the creation of another body, not responsible directly to
the military authorities, to do what is after all subsidiary work. The
inevitable tendency will be for the Red Cross to take on function after
function which should be undertaken by military authorities. The Red
Cross is already supplying many articles which should be, and can be,
supplied by Ordnance. For there is nothing that the Red Cross can supply
that Ordnance cannot still more easily supply. It is quite true that the
British Red Cross is managed on civil lines, and the British Red Cross
supplies goods and does not supply money. But with a full knowledge of
both systems we are strongly of opinion that the military method of
management is in every respect preferable.
During the Red Cross Inquiry recently finished, to which allusion will
be made elsewhere, day after day was necessarily spent by the Court in
endeavouring to decide what Red Cross should supply and what Ordnance
should supply. What does it matter so long as the patient receives the
articles? It does not concern him where they come from, and if the whole
is under military control there is no need for this sharp and artificial
line of demarcation. We are of opinion that in general the functions of
the Red Cross should be to supply those additional comforts and
accessories which make sick life more tolerable, to supply any goods
which may be donated, and to make helpful donations of money in the way
already indicated.
The presence in the store at Heliopolis of large quantities of
goods--sheets, blankets, pillows, and the like--which could have been
supplied by Ordnance, enabled us to rapidly tide over a great emergency.
There is no doubt that the possession of money and goods by the Red
Cross will prove of vast service in every campaign by reason of its
emergency value. In fact the rapid expansion of No. 1 General Hospital
during the crisis of May and June would not have proceeded with such
smooth expedition had it not been for the large quantities of Red Cross
stores which lay to hand and were instantly passed into the
Quartermaster's department. If, however, the supply had been under lay
control, we can quite imagine circumstances in which argument,
requisitions, forms, etc., might have seriously delayed operations.
Whilst on this subject reference must be made to the help afforded to
the hospitals by Red Cross workers. Two schools of thought existed. Some
Commanding Officers preferred to have no helpers, because of the trouble
some of them gave. Others passed to the other extreme. Our own
experience was that the workers organised by Mrs. Elgood were most
helpful for the functions they undertook, with one or two exceptions,
but those exceptional people gave a certain amount of trouble. They came
not to help, but to criticise, and they carried their criticisms not to
the Commanding Officer, but to the Australian public, and so caused
trouble.
We are convinced that the Japanese method of organising the Red Cross is
sound. It is organised and disciplined in time of peace, and when war is
declared it becomes part of the army medical reserve and is mobilised
for service. Every one is under military control, and consequently
these crudities are avoided. If we were to repeat our experience we
should have welcomed the visitors, but insisted that they should be
under some measure of discipline, and that a serious breach of
regulations should be followed by their withdrawal. In some instances
visitors wrote to the Commander-in-Chief, and complained of the food the
patients were getting. The Commander-in-Chief sent the letters on to us,
and we then brought the visitor in contact with the Commanding Officer
of the hospital, and the complaint was investigated. How much more
direct and simple it would have been if the visitor who saw something he
believed to be wrong had immediately asked for the Officer Commanding!
But the "secret and confidential" candid friend is apt to become
somewhat of a pest.
There is another and more serious aspect of the matter. The medical
officer is alone competent to judge what food should be issued to
patients. Visitors who criticise the diet of the patient are assuming a
function which they are obviously unable to discharge. Diet sheets are
provided for each ward, and on these is entered the number of different
diets prescribed by the medical officer. These diet sheets should be the
only and the final authority of what should be issued to the patient in
the way of eatables. As it happened, ladies sometimes brought into the
different wards of the hospital foods which constituted an added danger
to the patient. On one occasion green melons were issued to a large
number of sick men by kind-hearted visitors. The men became so ill that
the medical officer confiscated the melons, made inquiries, and only
then ascertained the source of supply. A strong-looking soldier on a
milk diet might evoke the sympathies of a lady visitor, who lodged a
complaint regarding the supply of food, but the nature of his disease
and the method of treatment adopted by his medical officer are surely
the principal consideration. As everything conceivable in the nature of
food and drink can be supplied through these diet sheets, the obvious
course is to pass all Red Cross foodstuffs directly into the
Quartermaster's department to be distributed in the ordinary, and the
only safe, channel. This was the practice followed at Heliopolis.
The following articles were supplied in this way at the time of
expansion, and show what assistance a properly controlled Red Cross
system can render.
QUARTERMASTER'S REPORT BY LIEUTENANT P. E. DEANE
ASSISTANCE RENDERED THE FIRST AUSTRALIAN
GENERAL HOSPITAL BY RED CROSS IN HOSPITAL
EXPANSION
_April_
Skating Rink opened.
Abbassia Venereal Diseases Hospital opened.
Casino Infectious " " "
The following were obtained immediately on requisition on Red Cross:
Sheets 1,684
Pillowslips 2,300
Face washers 1,600
Towels 2,622
Handkerchiefs 1,000
Blankets 61
Pyjamas 489
Cotton shirts 701
Underpants 400
Socks 600
Flannel shirts 400
Slippers 67
Draw sheets 500
Pillows 69
Quilts 12
Old linen cases 2
_May_
Great rush of patients--Luna Park expanded, Palace Hotel expanded.
Patients admitted in four days from
April 29 to May 2 1,543
Patients admitted during May 2,650
RED CROSS SUPPLIES
Sheets 1,381
Blankets 1,038
Towels 4,394
Pyjamas 1,176
Shirts 238
Handkerchiefs 500
Face washers 1,000
_June_
Rush of wounded continues. Atelier occupied, Sporting Club commenced.
Patients admitted during June 2,862
RED CROSS SUPPLIES
Pyjamas 790
Face washers 1,000
Sheets 900
Towels 1,500
Sponges 1,500
Handkerchiefs 1,500
Cotton shirts 950
Socks 1,000
Slippers 500
Pillowslips 1,000
Special hospital organised hurriedly by the department on June 17.
Ras el Tin Convalescent Home, Alexandria.
RED CROSS SUPPLIES
Socks 1,000
Shirts 1,500
Pyjamas 750
Sheets 750
Blankets 750
Pillowslips 750
Face washers 1,500
_July_
Wounded still pour in. Sporting Club increased by addition of
tennis court wards, Atelier and Luna Park accommodation
increased.
Patients admitted in July 2,194
RED CROSS SUPPLIES
Sheets 2,000
Slippers 1,000
Pillowslips 3,400
Blankets 1,900
Shirts 2,000
Handkerchiefs 2,000
Towels 3,000
Socks 3,400
Face washers 3,000
_August_
Choubra Infectious Hospital hurriedly established and equipped
by the department; 400-bed tent hospital added to Sporting Club.
RED CROSS SUPPLIES
Blankets 2,000
Cotton sheets 1,800
Towels 1,700
Handkerchiefs 2,400
Face washers 2,300
Socks 2,800
Pillowslips 214
CHAPTER X
SUGGESTED REFORMS--DEFECTS WHICH BECAME OBVIOUS IN
WAR-TIME--RECOMMENDATIONS TO PROMOTE EFFICIENCY--DANGERS TO BE
AVOIDED--CONCLUSION.
CHAPTER X
The experience gained in connection with the establishment and extension
of the First Australian General Hospital suggests modifications which
should immensely increase efficiency. A base hospital modelled on the
R.A.M.C. pattern may work exceedingly well in times of peace, or when
staffed by R.A.M.C. or I.M.S. officers who have devoted their whole
lives to the work. But base hospitals constructed during a great war,
and staffed almost entirely with civilian elements the majority of whom
are untrained in administration of any kind, do not work in all cases
with the necessary degree of smoothness. It certainly does appear that
changes in the base hospital establishment might be introduced with
advantage.
In the first place there arises the question whether it is necessary for
the Commanding Officer to be a medical practitioner, or whether, as in
the case of the convalescent hospitals, he might be a combatant officer,
or at all events a non-medical officer. The general consensus of opinion
is that he should be a medical officer, though there is a great deal to
be said on the other side. Almost the whole of his work is
administrative, though he necessarily must have a good knowledge of
clinical methods. But unless such an officer be selected not simply with
regard to seniority, but with regard to experience in administrative
methods, and unless he be tactful and watchful, troubles are very likely
to ensue. His task is beset with difficulties if he possesses character
and insists on efficiency. Whatever doubt there may be, however, about
the Commanding Officer, there need be none about many of the other
positions. A noteworthy feature of the First Australian General Hospital
was the continual complaint from the medical officers that they had not
come away to do administrative work. This distaste for administrative
work was a constant source of trouble.
The Registrar, as the principal executive officer of the hospital, whose
business it is to carry out the decisions of the Commanding Officer, is
at present invariably a medical officer. The greater part of his work
does not need medical knowledge, and the difficulty might be obviated by
the adoption of one of two methods. Either the Registrar might be an
educated business man or he might have such a one as his immediate
understudy. In the latter event a very small portion of his day would be
taken up with the duties of the Registrar's office.
Similarly the orderly officer, whose business it is to deal with details
concerning the rank and file, is usually a medical officer, and in some
hospitals it is the practice to change this officer from day to day. At
No. 1 General Hospital, however, his functions were so important that
one medical officer was permanently told off to do this work. There is
no doubt that the orderly officer need not be a medical officer, and
might well be an invalided combatant officer, transferred to the army
medical service.
Owing to modern developments another officer has made his appearance
who is not provided for in any establishment--that is, the transport
officer. Motor transport has become so large a portion of the work of
the base hospital that a special officer is requisite for the purpose.
There is no reason whatever why such an officer should be a medical man.
If these changes were made it would result in releasing at least three
officers for clinical purposes.
The amount of clerical work that was necessitated by the returns
furnished to the War Office, the Australian Government, Headquarters
Egypt, and other departments was so great that a large staff of very
competent clerks was required. The future establishment should certainly
include not only a number of trained stenographers, but some one versed
in statistical work. The lessons to be learned are so numerous and so
important that something of the kind should be done. Furthermore, in the
Quartermaster's department there was a demand not only for
stenographers, but for men who had been accustomed to the methodical
ways of a large warehouse.
Were all these changes made there is no doubt that the efficiency of the
administration would be increased and the burden of the work lightened.
As regards clinical work other desirable changes might be made. Senior
men who have been in full practice, and who come to a base hospital as
physicians or surgeons with the rank of lieutenant-colonel, are apt to
be entrusted with the detailed administration of medical or surgical
wards. They are often unfitted by training for such administration and
are frequently disinclined to undertake the work. It would be far
better to leave the actual detailed administration of the wards in the
hands of a comparatively junior man with the rank of major, and to
retain these senior officers as consultants only. Consultants of course
possess great powers, since their authority as regards the clinical work
itself is absolute. They can do as much or as little as they like, but
they are in complete control and are absolutely responsible for the
treatment of the cases. Our own feeling is that in such a position they
would be far more comfortable and would be more efficient.
On the subject of specialists there is much to be said. It is almost
incredible that a base hospital should have been formed without being
provided with an ophthalmic and aural specialist. The change has been
made since war began, but it seems inconceivable that any one should
have contemplated the efficient handling of wounds and diseases without
such aid. At the First General Hospital the ophthalmic and aural
department was the largest and most heavily worked department in the
hospital, partly owing to the fact that one of us had been appointed
Consulting Oculist to the Forces in Egypt, and that much of the work
consequently centred at Heliopolis.
Similarly the failure of the Australian Government to provide dentists
in the first instance is difficult to understand. The day has gone by
when it is possible to exclude from the force a man who possesses
dentures or defective teeth, and it is practically impossible to
complete the work for the recruits before they leave. So it became
necessary at No. 1 General Hospital to borrow two dentists from the New
Zealand Government, to fit them out with Red Cross money and goods, and
in this way to meet informally the difficulty. Subsequently the
Australian Government appointed a corps of dentists, and the problem was
to some extent solved, though even now the demand far exceeds the
supply. There is no doubt that dentists are wanted not only at the base
hospitals, but also near the firing line, as the dispatch of a man from
the firing line to the base hospital to obtain dental treatment
represents a waste of time and money.
It is further desirable to attach one or more anæsthetists to every
hospital.
It must, however, be said that the constant changes of staff which took
place at No. 1 Hospital owing to the various exigencies of the military
situation rendered it extremely difficult to keep a physician or surgeon
in any fixed position for any length of time. Consequently a certain
amount of pliability and adaptability was absolutely necessary. At the
same time, if the organisation were sketched in the manner indicated,
the problem would have been more simple, and good results easier to
obtain.
There is no doubt that one medical officer (who could be attached to the
Pathological Laboratory in addition to the Clinical Pathologist) should
devote himself entirely to sanitary work. This duty is not taken too
seriously, and should be emphasised. It would really be better to rename
this officer the "Prophylactic Officer," unless a better term can be
found, and it should be his aim and duty, not simply to enforce
cleanliness, but to actively exert himself to ward off disease.
Stress may be laid on the usefulness of a sensible chaplain, whose
value depends on his own interpretation of his duties. The chaplain
(Colonel Kendrew) at No. 1 General Hospital not only attended to the
religious needs of men, but earned their affection and respect by
managing the extensive post office and library, the canteen, and by
helping with Red Cross work. It is just these badly defined functions in
a base hospital which a chaplain can discharge so well.
We think also that women might be used in base hospitals as
stenographers, ward maids, telephone operators, and the like. Base
hospitals in the future are not likely to be housed in tents, and under
rough conditions. At present, trained nurses are sent to the Stationary
Hospitals. It seems a pity to waste fine young men, who could be
combatants, as orderlies in a base hospital.
Masseurs are certainly badly wanted in a base hospital, and it is
difficult to understand the objection to their incorporation. The
difficulty was removed in Egypt by employing Egyptians.
Electricians, _i.e._ orderlies who in civil life are electricians, are
required in every base hospital, and at Heliopolis they were invaluable
for general purposes, and as aids to the radiographer. They should,
however, form part of the establishment, and should number two or three.
Is it not clear that chefs, laundrymen, skilled carpenters, and other
tradesmen are also required?
The table which follows represents the establishment of the ordinary
520-bed hospital, R.A.M.C. It has been adopted by Australia, but the
Australian establishment allows for 93 nurses instead of 43. If the
foregoing suggestions are adopted, as we think they should be, this
table would require material alteration.
A GENERAL HOSPITAL (520 BEDS)
WAR ESTABLISHMENTS
----------------------+---------------------------------------------------
¦ PERSONNEL.
DETAIL. +---------+----+-----------+--------+--------+------
¦Officers.¦W.O.¦St. Sergts.¦Buglers.¦Rank and¦Total.
¦ ¦ ¦and Sergts.¦ ¦ File. ¦
----------------------+---------+----+-----------+--------+--------+------
Lieut.-Col. in charge ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1
Lieut.-Cols. ¦ 2 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2
Majors-- ¦ ¦ ¦ ¦ ¦ ¦
Sec. and Registrar ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1
General Duties ¦ 4 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 4
Captains or Subs. ¦ 12 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 12
Quartermaster ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1
Warrant Officers ¦ -- ¦ 2 ¦ -- ¦ -- ¦ -- ¦ 2
Sergeants-- ¦ ¦ ¦ ¦ ¦ ¦
Nursing Duties ¦ -- ¦ -- ¦ 4 ¦ -- ¦ -- ¦ 4
Steward ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1
Dispenser ¦ -- ¦ -- ¦ 2 ¦ -- ¦ -- ¦ 2
Cook ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1
Pack Storekeeper ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1
Linen " ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1
Clerks ¦ -- ¦ -- ¦ 3 ¦ -- ¦ -- ¦ 3
Buglers ¦ -- ¦ -- ¦ -- ¦ 2 ¦ -- ¦ 2
Corporals-- ¦ ¦ ¦ ¦ ¦ ¦
Steward ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
Cook ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
Clothing Storekeeper¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
General Duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
Supernumeraries ¦ -- ¦ -- ¦ -- ¦ -- ¦ 3 ¦ 3
Privates-- ¦ ¦ ¦ ¦ ¦ ¦
Steward's Stores ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 ¦ 2
Cooks ¦ -- ¦ -- ¦ -- ¦ -- ¦ 3 ¦ 3
Pack Stores ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
Linen " ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
Clothing " ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1
Clerks ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 ¦ 2
Ward duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 66 ¦ 66
Batman ¦ -- ¦ -- ¦ -- ¦ -- ¦ 25 ¦ 25
General Duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 11 ¦ 11
Supernumeraries ¦ -- ¦ -- ¦ -- ¦ -- ¦ 6 ¦ 6
----------------------+---------+----+-----------+--------+--------+------
TOTAL ¦ 21 ¦ 2 ¦ 13 ¦ 2 ¦ 126 ¦ 164
----------------------+---------+----+-----------+--------+--------+------
With reference to the duties of N.C.O.s and men, nothing gave more
trouble than the fact that men recruited in Australia were made N.C.O.s
before their special qualifications were known. There is no officer in
the Army whose position is so thoroughly safeguarded as the N.C.O., and
nothing but the adverse decision of a court martial can effect his
removal. Yet an unsuitable and even dangerous man, from the point of
view of the sick, may do nothing to warrant a court martial (which no
one enjoys). These appointments should be made therefore with great
care. Such considerations, of course, lead to but one conclusion, viz.
the necessity for sketching out these hospitals in time of peace.
Scratch enlistments are too dangerous.
The "grouser" is always with us, and sometimes gives trouble. The
particular Australian "grouse" was that the Australian hospitals should
have been nearer the front than Cairo, and at last No. 3 Australian
General Hospital was placed at Mudros.
Now we have always understood that a large base hospital cannot be
placed far from a great city. A city grows in a particular place for
natural reasons--water supply, lighting, transit, etc. The hospital gets
the benefit of all these agencies, whereas it was necessary at Lemnos to
create them. The result was somewhat disastrous as regards supplies, and
might have been foreseen.
"Grousers" should stay at home, and exercise their privileges there.
The difficulties of obtaining supplies by requisition were easily
surmounted at Heliopolis because of the broad policy adopted by the
Officer Commanding the Australian Intermediate Base, Colonel Sellheim,
C.B.
[Illustration: N.C.O.S AND MEN, NO. 1 AUSTRALIAN GENERAL HOSPITAL.
_To face page 197_]]
Ordnance cannot supply the varied requirements of a group of expert
medical officers during a great war, and delays cause untold annoyance
to active men. On the other hand, it would never do to give the staff a
free hand to purchase when and how it pleased.
The institution of "local purchase orders" met the difficulty. The O.C.
of the hospital sent in a requisition for something which could not be
obtained from Ordnance, marking it "urgently required." The A.D.M.S.
endorsed it, or, if it were an entirely new line, asked the D.M.S. to
endorse it. The Ordnance officer then issued a local purchase order to
the medical officer, who made the purchase. The method combined a
measure of control with reasonable speed in execution.
We have no sympathy with the usual references to military red-tape. If
the administration is competent, the military system is thoroughly sound
from the business point of view, and from the standpoint of record
difficult to improve on. It may be at times a little cumbersome, but it
is much easier to fall in with it than to attempt to effect alteration
during war. We never had any real difficulty with requisitions, although
supplies were sometimes withheld from us on grounds of policy not
disclosed at the moment.
There is no doubt that the erratic changes of staff were injurious. Some
medical officers preferred the front, others the base, and an attempt
was made to effect an orderly system of periodical exchange. Orders,
however, were continually arriving to send so many medical officers, so
many nurses, and so many orderlies, here and there, with the result that
at the end of ten months the original medical staff had disappeared,
many of the nurses were new, and so were most of the orderlies.
Whenever there was a shortage of staff near the front, the base
hospitals were depleted. These changes were inevitable in the
circumstances, but they emphasised the value of the advice given by
Colonel Manifold, that there cannot be too many unattached junior
medical officers in a campaign.
The following report from Major Brown, Officer Commanding Luna Park No.
1 Auxiliary Hospital, shows what he experienced owing to these
oscillations:
FIRST AUSTRALIAN GENERAL HOSPITAL, LUNA PARK
April 30 Opened with 296
patients
May 2 790 patients Staff: 4 sisters, 4 orderlies,
and myself. With
Captains Bentley, McDonald,
and White
from Light Horse
Regiments.
May 6 Sisters increased to 13.
May 14 1,171 patients 13 sisters, 4 medicos, and
40 orderlies (mostly
untrained).
May 18 1,244 patients
June 7 1,099 patients 41 sisters (new).
(also 65 Casino)
June 9 1,370 patients " " "
(also 65 Casino)
June 11 1,620 patients
(also 65 Casino) " " "
June 16 1,520 patients Still 4 medical officers,
Capt. Brown, Capt.
Single, Capt. Lovegrove,
and Capt. Craig.
June 17 Medical officers now increased;
sisters also
increased.
[Illustration: PALACE OF PRINCE IBRAHIM KHALIM (NURSES' HOME).
_To face page 198_]]
With reference to orderlies, the work from May 3 has been done with 10
A.M.C. men and 30 men drawn from the patients.
On June 17, 40 reinforcement A.M.C. men were detailed for duty. Up to
June 16 over 1,600 patients have been discharged. On May 23 the
Operating Theatre was opened.
For the 1,600 patients we had six cooks with six natives to assist.
T. F. BROWN, _Captain_,
_Officer in Charge, Luna Park_.
HELIOPOLIS,
_June 17, 1915_.
Of the 93 nurses belonging to the hospital, within a week of landing no
fewer than 47 were taken away and dispatched to various parts of Egypt,
viz.:
Port Said (Clearing Hospital) 21
Pont de Koubbeh (Egyptian Army H.) 9
The Citadel (British Hospital) 6
Alexandria 2
Transport duty 8
Returned to Australia (sick) 1
__
47
__
No. 1 Australian General Hospital was much inspected by keen and
curious, as well as sympathetic, eyes. His Highness the Sultan, Their
Excellencies Sir Henry and Lady MacMahon, the General Officer
Commanding-in-Chief, Egypt, the General Officer Commanding Australian
and New Zealand Army Corps, and many other distinguished people honoured
the hospital by an inspection.
The following letters were written by three distinguished visitors. Two
Corps Orders are also attached.
"SHEPHEARD'S HOTEL, CAIRO,
"_May 20, 1915_.
"DEAR COLONEL RAMSAY SMITH,
"Allow me to congratulate you upon the admirable medical arrangements at
Heliopolis, and upon the excellent hospital you have established there.
One is at first disposed to say, 'How well the building adapts itself to
a hospital!' until the true fact becomes revealed of the genius
displayed in converting a decidedly refractory building into a place for
the sick. You and your staff have done wonders and have once more shown
that in the land of Egypt 'it is possible to make bricks without straw.'
"Australia may well be proud of the part she has played in this war, and
I can pay no higher compliment than by saying that the medical
arrangements of the Australian Army are as splendid as are the fighting
qualities of its men.
"Above all I was impressed with the energy and enthusiasm with which the
work at Heliopolis is being carried on, with the ingenuity and resource
displayed at every turn, and with the thoroughness that was manifest in
every department of the vast hospital.
"The generosity with which Australia has provided motor ambulances for
the whole country and Red Cross stores for every one, British or French,
who has been in want of same is beyond all words.
"I only hope that the people of Australia will come to know of the
splendid manner in which their wounded have been cared for, and of the
noble and generous work which the great colony has done under the banner
of the Red Cross.
"Yours sincerely,
"(Signed) FREDERICK TREVES."
[Illustration: GORDON HOUSE, HELIOPOLIS (NURSES' HOME).
To _face page 200_]]
"TURF CLUB, CAIRO,
"_June 21, 1915_
"DEAR COLONEL RAMSAY SMITH,
"I am just off to the Dardanelles, and then back to Cairo, but I felt
that I must write and thank you for your kindness in sending me those
excellent and interesting photographs, which I shall treasure, and the
memory of the interesting day I spent with you at your wonderful
hospital. I also thank you for your report and for the copy of Sir F.
Treves's letter.
"You must feel proud of your work at Heliopolis, on which I heartily
congratulate you. It is a monument of skill in administration and the
surmounting of what would at first appear to be insurmountable
difficulties.
"Hoping soon to see you again,
"Yours very sincerely,
"(Signed) A. W. MAYO-ROBSON."
"ST. MARK'S BUILDINGS, ALEXANDRIA,
"_June 5, 1915_.
"DEAR MAJOR BARRETT,
"I have been away at the front or I should have written to you sooner to
thank you for the interesting visit which you enabled Sir Frederick
Treves and myself to pay to your hospital and stores. I enclose an
extract of a report which I made on May 25 to the Hon. Arthur Stanley,
Chairman of the British Red Cross Society and Order of St. John in
London.
"You may have noticed a minute published in the press with the approval
of the G.O.C., Sir John Maxwell, in which it was laid down that all Red
Cross work, except the Australian Red Cross work, should be under the
control of the British Red Cross and Order of St. John. I hope you will
not think that in drafting this minute in this way I wished to convey
that we were not working in perfect harmony with your Red Cross, but I
feel that we could hardly suggest to you that you should be in any way
under our control. At the same time, I hope that when you either come
here, or when I come back to Cairo, that we may have an opportunity of
conferring together so that we may so co-ordinate as far as possible our
mutual work.
"May I add that I went to the Dardanelles in a transport with over a
thousand of your brave soldiers, many of whom were returning to the
Peninsula after having already been wounded. It is impossible to speak
too highly of their gallantry, and of the splendid spirit they
displayed. I need not tell you that I heard of their fighting qualities
at the front, since their heroic deeds in this campaign have already
become a matter of history.
"Yours sincerely,
"(Signed) COURTAULD THOMSON,
"_Chief Commissioner for British Red
Cross and Order of St. John, Malta,
Egypt, and Near East Commission._"
[_Copy_]
EXTRACT FROM A REPORT FROM LIEUT.-COLONEL SIR COURTAULD THOMSON,
CHIEF COMMISSIONER OF THE BRITISH RED CROSS AND ORDER OF ST.
JOHN, TO THE HON. ARTHUR STANLEY, DATED MAY 25, 1915.
"A striking feature in Cairo is the remarkable work which is being done
by the Australian Red Cross. They have not only two exceptionally large
hospitals and the large convalescent home, but they supply the motor
transport for the wounded for the whole of Egypt. They have also very
large Red Cross stores which they have brought with them. With these
articles they have been more than generous, and I am informed that they
have given away to the hospitals for our own troops something like 75
per cent. of whatever they had."
EXTRACT FROM CORPS ORDERS, MARCH 28, 1915
"_Appreciation._--The D.M.S. Egypt, who visited the Hospital yesterday
afternoon, has requested the Officer Commanding to convey to the
officers, nurses, N.C.O.s, and men in the Hospital his appreciation of
the work done and the thorough character of the organisation."
EXTRACT FROM CORPS ORDERS, MAY 1, 1915
"_Appreciation._--The D.M.S. Egypt, Surgeon-General Ford, witnessed the
detraining of the invalids who arrived here Wednesday evening. He asked
Major Barrett to convey to the Officer Commanding his great appreciation
of the excellence of the arrangements and the efficient and quiet manner
in which the work was done.
"He congratulates officers and men on the splendid work they are doing
and requests that it shall be communicated to them in Corps Orders."
Looking back, does it not seem essential that these hospitals should
have been formed, at all events in outline, in time of peace? That their
commanding officers and essential staff should have been marked out
beforehand, so that on the declaration of war the gaps could have been
filled in from the reserve without difficulty? Satisfactory appointments
are much less likely to be made in the turmoil which follows the
declaration of war than in the atmosphere of deliberate calm which
prevails in time of peace. Had such an arrangement prevailed, the First
Australian General Hospital would certainly never have been recruited
from three States distant from one another hundreds of miles.
Finally, Australian hospitals in time of war should either be regarded
as responsible solely to the Australian military authorities and
Government, or handed over without reserve to the R.A.M.C., and placed
entirely under the control of the British authorities. Where two
different authorities exist, as in the case of the First General
Hospital, a large amount of trouble and delay is almost certain to
ensue. The adoption of the latter course is in our judgment absolutely
essential if efficiency is to be secured.
As is invariably the case, weaknesses in any system are only revealed by
costly experience. But while in the Australian Medical Service the
experience need not have been so costly, we can at least profit by what
has occurred, and frame a stronger and a better policy for the future.
[Illustration: AUSTRALIAN CONVALESCENT HOSPITAL, AL HAYAT, HELOUAN.
_To face page 204_]]
On the whole, the record of work done in most trying circumstances is,
we think, satisfactory. It is true that the universal democratic fault
was evidenced in the lack of preparation for conditions which were
fairly obvious. Nevertheless the adaptability and growth of the
hospitals in time of great emergency were achievements of the highest
order.
Yet it would be unwise to leave the subject with the usual Anglo-Saxon
expression of satisfaction that the crisis was passed. The history
reviewed has too deep a significance. It must be regarded not merely as
an individual incident, but as an indication of the inefficiency
evidenced by too many departments of the Empire.
The causes which found the medical services unprepared, which forced
them to expand to the breaking-point, and which led to the criticism of
the hospital authorities, are not departmental or sectional--they are
national. If attacks on individuals are permitted, initiative will be
stifled; if on the other hand we are content to follow the time-worn
policy of "muddling through," the virile people who skirt the border
lines of our Empire will sooner or later bid us make way for stronger
men.
Our policy for the future must be one of scientific organisation and
calculated preparation in every department. We must not only appoint
capable administrators, but also trust them. We can again, if we like,
obtain that temporary mental tranquillity which comes to a
democracy--and to an ostrich--which does not or will not see the
calamity which threatens it, but temporary beatitude will be purchased
at the price of an Empire. Never was it more certainly true that the
price of liberty is eternal vigilance.
CHAPTER XI
POSTSCRIPT
CLOSURE OF AUSTRALIAN HOSPITALS--THE FLY CAMPAIGN--VENEREAL
DISEASES--Y.M.C.A. AND RED CROSS--MULTIPLICITY OF
FUNDS--PROPHYLAXIS--CONDITION OF RECRUITS ON ARRIVAL--HOSPITAL
ORGANISATION--THE HELP GIVEN BY ANGLO-EGYPTIANS.
One of us (J. W. B.) was invalided to England in the middle of November
1915, and returned to Egypt at the end of March 1916.
He resigned his commission in the Australian Army Medical Corps on
February 28, and was appointed temporary Lt.-Col. in the R.A.M.C. on
February 29. On his return to Egypt he was appointed Consulting Aurist
to the Forces in Egypt, and was a member of the Council of the British
Red Cross Society and of the Y.M.C.A. He consequently had an opportunity
of witnessing the termination of many of the arrangements for which he
had been in part originally responsible, and desires to make brief
reference to them.
No. 1 Australian General Hospital with its many off-shoots, including
the four auxiliary hospitals and the venereal disease hospital, was
located in Egypt for periods of twelve to eighteen months. No. 2
Australian General Hospital was in Egypt about fourteen months. Yet it
was stated that each and every one of these hospitals when established
were to be temporarily located in Egypt for a few weeks. Luna Park,
_i.e._ No. 1 Auxiliary Hospital, was in existence approximately sixteen
months. An enormous number of sick and wounded, said to be 18,000, was
passed through it with an infinitesimal death-rate, viz. four or five
persons. Since the end of 1915, the No. 3 Australian General Hospital
was moved from Mudros to the Barracks at Abbassia, Cairo. The
expenditure necessary to fit the barracks for the reception of No. 3
Australian General Hospital and the time taken are very interesting,
since they show how utterly impossible any such arrangement would have
been during the inrush of wounded in 1915. Stress is laid on the value
of auxiliary hospitals as the only practicable means of surmounting
difficulties at that time, in the report of the Committee of Inquiry
into the Administration of the Australian Branch British Red Cross in
Egypt.
Looking back at the practical conclusion of the work of the Australian
Army Medical Corps in Egypt, it is quite evident that the policy
originally adopted was the only one possible in the circumstances, and
the results have fully justified it.
THE FLY CAMPAIGN
Very active steps were taken during 1916 in the direction of a campaign
for the destruction of flies. The only addition that need be made to
previous remarks is reference to the ingenious fly traps which have been
devised. A large one was designed by Lt.-Col. Andrew Balfour, C.M.G.,
and is described in the journal of the Army Medical Corps of July 1916.
A modified form of this trap, furnished by the British Red Cross in
Egypt, costs about 16_s._, and was most effective. These traps have been
known to catch as many as 20,000 flies a day.
The smaller trap, which can be used indoors, and is made of zinc gauze,
was made in large quantities by the British Red Cross Society in
Alexandria, and distributed throughout Egypt.
Another kind of trap, a Japanese invention, with clockwork mechanism,
manufactured by Owari Tokei, Kabushiki, Kwaisha, Japan, has also been
very successful. As many as 3,000 flies have been captured in one
instance in an hour. It has a considerable advantage over the other
traps in that its mechanism interests everyone.
Like all fly traps, however, the utility of these devices depends upon
placing them in the hands of men whose business it is to see that they
are properly baited and cared for, and on some ingenuity with regard to
the baits. For the larger traps placed out-of-doors the best baits were
found to be fishes' heads or the entrails of fowls, whilst the best bait
for the smaller indoor trap was a mixture of beer or whisky and sugar.
It is, of course, quite evident that the destruction of flies by traps
is not logically sound, since the proper method of control of the fly
pest is by the destruction of all refuse; but as that is impracticable
in Egypt, the traps were of great assistance.
In 1916 the fly pest as usual became marked during two periods in the
year; viz. at the beginning and the end of summer. At the height of
summer the dryness and desiccation evidently prevent the breeding of
flies, a fact to be borne in mind in Australia.
The returns given in the House of Commons respecting the Gallipoli
Campaign place the casualties at 116,000, and the cases invalided at
96,000. As a very large number of the cases of the sick were due to
intestinal infections, some idea of the damage which may be caused by
flies can be imagined.
The discovery of bilharzia eggs and the organisms of dysentery and
diarrhoea in the fæces of flies made it clear that the fly plays an even
larger part in disseminating disease than has hitherto been understood.
It really would appear that if the flies were destroyed infective
diseases would fall to small proportions.
THE VENEREAL-DISEASE PROBLEM
The venereal-disease problem in the early part of 1916 gave very great
concern, and active measures were taken to deal with it. In spite of all
the ameliorating influences the problem reached its most serious phase
in March and April 1916, as questions put in the House of Commons show
(_vide_ _Lancet_, April 8, 1916). I think I express the conviction of
certainly 90 per cent. of medical men in stating that nothing but
education and educated prophylaxis will ever enable us to get rid of
this source of destruction.
Y.M.C.A. AND RED CROSS
The Soldiers' Club in the Ezbekieh Garden grew in favour and was
extended in area and staff. In the autumn of 1915 some ladies became
available, and did splendid service in the superintendence of the
catering for the men in the Club, and by their presence there did much
to help.
A more extended experience of the work of the Y.M.C.A. and of the Red
Cross has given much cause for thought. The Y.M.C.A. organisation
appears to me to be excellent, since it is the organisation which caters
for the social welfare of the soldier, wherever he may be, whether in
camp or at the base; and the work is conducted by men whose business it
is to understand him and see that all reasonable wants are gratified. In
Egypt as I write (July 1916) there are no fewer than forty-seven
Y.M.C.A. huts and centres, and Y.M.C.A. officers in the desert, in the
oases, and elsewhere, doing their very best to make the soldiers
comfortable. In other words, the business of the Y.M.C.A. is to provide
comfort by personal service over and above military necessaries for the
men who are well.
The Red Cross Society, on the other hand, attends to the wants of the
sick and wounded, and its functions have already been discussed. They
may, however, be supplemented by the following definition of the work of
the Red Cross which was furnished by the High Commissioner for Egypt,
Sir Henry MacMahon:
"Government supplies all the necessities for the care, treatment, and
transport of the sick and wounded, while the Red Cross supplements these
necessities by everything that can in any way go to the comfort and
well-being of the sick and wounded soldiers. The distinction between
necessities and comforts is sometimes so indefinite that the Red Cross,
wherever possible, endeavours to have both ready to hand for use when
needed."
And later:
"A word must be said here about the work of the Red Cross Stores. The
object of the Red Cross has never been to supply in any large quantities
the goods which the War Office sends to the wounded, but it does its
best to provide the troops with such things as the War Office does not
supply at all or cannot supply at a given time. A State Department,
bound as it rightly is by hard-and-fast rules, cannot work as quickly as
a private body with more elastic regulations; moreover, the supplies of
any department may change at times, hence it happens that the British
Red Cross occasionally supply certain things more than the War Office
can, or it may supplement the War Office supplies, and it does so until
the War Office steps in again. Further, the Red Cross supplies many
things or small luxuries which the authorities cannot possibly supply,
and these are just the things which are most appreciated by the sick and
wounded."
In other words, the function of the Red Cross is to assist over and
above necessity, and to be ready to act in event of emergency.
The following lists of the Australian Branch and Egyptian Branch of the
British Red Cross show that in both cases, but particularly in the case
of the Australian Branch, the Red Cross is supplying articles which
should clearly be supplied by Government. There is considerable danger
in allowing this system to become too largely developed. In the first
place in the case of the Red Cross there is no rigid system of
accountancy such as military regulation requires, and the natural
tendency for commanders will be to get goods in the easiest possible
manner; nevertheless, it may not be the best thing for the service.
The British Red Cross safeguards the practice more fully than the
younger branch, and its lead might well be followed. (See Lists on pp.
212-216.)
AUSTRALIAN BRANCH BRITISH RED CROSS SOCIETY
LIST OF ARTICLES IN RED CROSS STORES WHICH MUST BE REQUISITIONED
FOR BY COMMANDING OFFICERS OF UNITS FOR THE CARE OF THE SICK AND
WOUNDED AND WHERE THERE IS NO RED CROSS STORE.
1916
_To the Commissioners,
Australian Branch British Red Cross Society,
Shepheard's Hotel, Cairo._
Please send to ---------------- the following articles:
Quantity Description
_Clothing_
Balaclava Caps
Cardigans
Cholera Belts
*Cushions, Air
* " Ordinary
Dressing Gowns
Facewashers
Fly Veils
Gloves
*Handkerchiefs
Mittens
*Mosquito Nets
Mufflers
*Pillows
*Pillow Slips
Pneumonia Jackets
*Pyjamas, Cotton
* " Flannel
*Quilts
*Sheets
*Shirts, Cotton
* " Flannel
* " Hospital
*Shoes, Deck
*Slippers, Hospital
*Socks
* " Bed
*Surgeons' Aprons
* " Caps
* " Gowns
* " Swabs
*Towels
* " Glass
Underpants, Cotton
" Flannel
Undershirts, Cotton
" Flannel
_Foodstuffs_
Allenbury's Diet
" Food
Arrowroot
Beef Extract
Benger's Food
Biscuits
Bovril
Brandy
Ceregen
Chocolate
Cocoa
Cocoa-and-Milk
Coffee Essence
Coffee-and-Milk
Condensed Milk
Cornflour
Cornina
Fruits, Dried
" Tinned
Glaxo
Horlick's M. Milk
Jam
Jelly Crystals
Lactogen
Lime Juice
Linseed Meal
Malt Extract
Oatmeal
Pickles
Plum Puddings
Port Wine
Robinson's Barley
" Groats
Semolina
Soda Water
Sweets
Tapioca
Tinned Rabbits
" Tomatoes
" Tripe
" Vegetables
_General_
*Absorbent Wool
*Bandages
*Bed Cradles
* " Rests
* " Screens
Books
*Brushes, Hair
* " Nail
* " Tooth
*Camp Stools
Cigarettes
*Combs
*Crutches
*Deck Chairs
Eau-de-Cologne
Envelopes
Fly Veils
Fly Whisks
Gramophone Needles
*Hospital Basins
*Hot-water Bottles
Housewives
*Insectibane
Looking-glasses
Matches
*Medicine Glasses
Old Linen
*Oil Heaters
Pencils
Periodicals
Pipes
*Primus Stoves
*Razors
*Razor Strops
*Rubber Sheeting
*Safety Pins
*Smoked Glasses
*Soap, Monkey Brand
*Soap, Shaving
* " Toilet
*Splints
*Sponges
*Tables, Folding
*Thermometers
Tobacco
*Toilet Paper
Tooth Paste
*Vaseline
Writing Pads
_Note A._--As a general rule the Commissioners only supply goods that
cannot be obtained from either Ordnance Dept. Army Service Corps, or
Base Medical Depot Stores. Any O.C. requisitioning for goods of a kind
properly obtainable from those sources should state on the requisition
that the goods applied for cannot be obtained from the usual source.
_Note B._--Regimental Medical Officers can obtain their requirements
from the O.C. of the nearest Field Ambulance, who will forward
requisitions to Red Cross.
----------------
Officer in charge of Hospital.
[All the articles marked * were permanent Government issues, and any of
the foodstuffs would have been supplied by Government if necessary.
There was no practical difficulty in obtaining any articles from
Government on proper application being made.]
BRITISH RED CROSS AND ORDER OF ST. JOHN
_No. of Patients_ -------- _For the Use of Patients_
LIST OF ARTICLES IN RED CROSS STORES WHICH MAY BE
REQUISITIONED FOR.
---------------- 191
_To the Commissioner_,
_British Red Cross and Order of St. John_
_Gresham Buildings, Cairo._
Please send to ----------------
the following articles:
Quantity Description
B.D.M.S. Air Beds (Rubber)
Air Rings (Rubber)
B.D.M.S. Air Cushions (Rubber)
Ash Trays
Balaclava Helmets
B.D.M.S. Bandages
Bandage Winders
B.D.M.S. Bellows (for Air Beds)
O.D. Bed Pans
O.D. Bed Rests
O.D. Bed Trays
Bed Jackets
Bed Pockets
O.D. Blankets
Blacking
B.D.M.S. Boric Lint
Books and Magazines
Boot Brushes
A.S.C. Bovril
Biscuits
Brandy
O.D. Camp Stools
O.D. Caps
O.D. Cardigans
Carrying Chairs
Cholera Belts
Chocolate
A.S.C. Cigarettes
Cloths (Pantry and Kitchen)
O.D. Combs
B.D.M.S. Cotton Wool
B.D.M.S. Crutches
Dressing Gowns
Dressings
Deck Chairs
Eau-de-Cologne
Face Flannels
Face Nets
Fans
O.D. Fly Whisks
Fly Veils
Food Slicers
O.D. Feeding Cups
Games
B.D.M.S. Gauze Tissue
Goulas
Gramophones
Hair Brushes
O.D. Handkerchiefs
Head Shields
O.D. Hot-water Bottles and covers
B.D.M.S. Ice Bags
Jug Covers
Kit Bags
B.D.M.S. Linen (Old for Bandages)
A.S.C. Matches
Mirrors
O.D. Mosquito Netting
O.D. Mugs, Enamelled
O.D. Mufflers
Mittens
Nail Brushes
Nightingales
Officers' Outfits
Operation Stockings
O.D. Overalls
O.D. Pants
Pencils
Pipes
O.D. Pillows
O.D. Pillow Cases
Playing Cards
Pneumonia Jackets
Post Cards
O.D. Pyjamas
O.D. Razors
Razor Blades
Reading Matter
Rum
B.D.M.S. Rubber Gloves
O.D. Shaving Brushes
Soap (Toilet)
Spirits
Stationery
Sweets
Sun Hats
O.D. Shirts (Flannel)
" (Cotton)
" Helpless Case
" Helpless Case (Night)
O.D. Screens
O.D. Sheets
O.D. Socks
Sponges
O.D. Slippers
B.D.M.S. Swabs
Testaments
O.D. Tooth Brushes
Tooth Powder
A.S.C. Tobacco
O.D. Towels
O.D. Urinals
Vests
Walking Sticks
Whisky
Wool, Absorbent
B.D.M.S. Water Beds
B.D.M.S. Waterproof Sheeting (Pluviusin)
_Extras_
_Items marked_--
_A.S.C._ (_Army Service Corps_),
_O.D._ (_Ordnance Dept._),
_B.D.M.S._ (_Base Depot Medical Stores_),
will only be provided by the British Red Cross on the understanding
that the Military Departments have been applied to and cannot supply, or
that it is a case of grave or unexpected emergency. Such a demand to be
supported by signature of O.C. Hospital, which implies he has indented
on the department concerned and failed to obtain.
_N.B._--_All indents to be countersigned by the O.C. Hospital._
The British Red Cross has definitely been placed under military control,
and the Chief Commissioner has been attached to the staff of the
Commander-in-Chief. The work goes on just as usual, but if necessity
arose the Commander-in-Chief could exercise his authority.
I understand that in France the Australian Branch British Red Cross has
now been placed under military control; the Director of Medical
Services, Australian Expeditionary Force, being Chief Commissioner and
the other commissioners and officers being graded with various ranks. To
me this arrangement is definitely a step in the right direction, though
I still think the British system in Egypt is better. The officers of the
Red Cross in Egypt have no rank, but are under military direction, and
the Chief Civil Commissioner is attached to the staff of the
Commander-in-Chief; he has had the rank of Hon. Colonel since the war
began. It is interesting, however, to note that the Australian Branch
British Red Cross has passed through four phases, so far as the work in
the field is concerned:
(1) It was a purely military organisation.
(2) When the High Commissioner in Egypt was requested to form a
committee it became a combined civil and military organisation.
(3) When the Australian commissioners were appointed it became a purely
civil administration.
(4) It has finally become a combined civil and military organisation, in
which the military element holds control.
This step further indicates the logical development, in my judgment, of
both the Y.M.C.A. and the Red Cross. They should both be regarded as
definite branches of the service. They should both be organised in time
of peace largely as independent organisations, and as part of the
Reserve, and, on declaration of war, they should be incorporated in the
service and placed under military control. The function of the one would
be to attend to the social wants of the men who are well, the other to
attend to the wants of the men who are sick and wounded.
I do not think that any other funds or societies should be permitted to
interfere with military arrangements; all those who desire to help with
money, with goods, or with personal assistance could do so through the
one channel or the other.
As a corollary to the foregoing it is evident that there should be only
one voluntary war fund, which should be placed under the control of a
committee representing the Y.M.C.A., the Red Cross, and nominees of the
Government and public, who could allocate the money subscribed to the
Y.M.C.A. or Red Cross as necessity arose. The following list shows the
unnecessary multiplicity of organisations and funds in the State of
Victoria alone, viz. at least seventeen societies in a community of
about one million and a half people. Even in Egypt enthusiastic people
started an "Australian Comforts Fund," a "Soldiers' Outings
Association," "Camp Welfare Association," and so forth, and these bodies
simply did for varying periods the work of the Y.M.C.A. or the Red
Cross as the case may be, in a more or less patchy way.
MULTIPLICITY OF FUNDS
(_From "The Argus," Melbourne, 1916_)
"WAR RELIEF FUNDS
"OBJECTS OUTLINED: A GUIDE TO GIVING
"It is only when one sees the complete list of war relief funds compiled
by the State War Council, in connection with its announcement regarding
the supervision to be exercised over future collections, that the full
extent of the relief organisations and the wide scope covered by the
Victorian public's generous giving are appreciated. There are in
existence here a score of war funds of one kind or another, and by the
devoted efforts of their organisers and the warm-hearted support of the
public the lot of our soldiers has been brightened, the burden of pain
and suffering borne by the sick and wounded has been eased, a helping
hand has been extended to the homeless, broken sufferers of Belgium,
Poland, and Serbia, and a gleam of happiness brought to many a home in
France whose erstwhile bread-winner is on active service.
"All the Victorian organisations have clearly defined objects, and are
working along sound lines. The list of funds is to be increased shortly
by the creation of a Repatriation Fund the details of which are now
being worked out. The money raised will be devoted to the settling in
suitable employment of soldiers who have fulfilled their service. A
similar object is aimed at in the repatriation scheme which has been
launched with such marked success by Mr. Rodgers, M.H.R. The objects of
the other funds, which have been and are doing so much, are thus
summarised for the information of the public by officials of the
organisations:
"_British Red Cross Society_
"(Australian Branch)
"Objects officially stated as--'Red Cross work, to assist all hospitals
in time of war.'
"_Victorian Red Cross Fund_
"For Australian sick and wounded soldiers (Lady Stanley Appeal). The
proceeds are being and will be remitted to the Australian Red Cross
Society, to be used by it for the benefit of Australian sick and wounded
soldiers and institutions in which they may be treated.
"_Red Cross Society_
"(Victorian Division)
"Objects officially stated to be 'those of the Geneva Convention.'
"_French Red Cross Society_
"The raising of funds for the work of the French Red Cross Society.
"_Australian Patriotic Fund_
"For the benefit of Victorian soldiers and their dependents, soldiers
from any part of Australia and their dependents, other deserving objects
consequent on service at the war, and the augmenting of pensions granted
by the Commonwealth.
"_State War Council's Fund_
"For discharged soldiers. Its object is to assist in re-establishing
discharged soldiers in employment.
"_Commonwealth Button Fund_
"A collecting body, which has used its organisation for collecting for
various funds. It has collected for the Belgian Fund, Red Cross Society,
Lady Stanley's Appeal, French Red Cross, Serbian Fund, Italian Fund,
Russian Polish Fund, and for institutions at the front and in camps
belonging to the different churches and the Y.M.C.A.
"_Lady Mayoress's Patriotic League_
"To assist in providing comforts, extra clothing, and foods for the
fighting men in the navy and army.
"_Belgian Relief Fund_
"To assist in relieving distress in Belgium.
"_Serbian Relief Fund_
"To assist in relieving distress amongst the Serbians.
"_Polish Relief Fund_
"To assist in relieving distress amongst the Russian Poles.
"_French Société Maternelle Fund_
"To collect funds for the Société d'Assistance Maternelle et Infantile.
The fund is administered in France, money and goods being collected here
and sent forward.
"_Y.M.C.A. National Appeal_
"For the benefit of soldiers in camps, on troopships, and abroad, by
providing recreation, games, stationery, literature, and comforts, and
ministering generally to the moral and spiritual welfare of the
Australian troops.
"_Commonwealth Service Patriotic Fund_
"Objects determined, as necessity arises, by a committee consisting of
heads of departments and branches. Allocations to different funds.
"_State Service Patriotic Fund_
"Relief of distress resulting from the war.
"_Education Department Patriotic Fund_
"Relief of distress caused by the war, and for providing clothing and
comforts for our troops.
"_Railways Department Patriotic Fund_
"Relief of distress in Belgium, relief of distress due to unemployment
in Victoria, and Red Cross purposes in the proportion as nearly as
practicable of one-third to each."
An additional advantage of the arrangements proposed would be that all
those who assist would be under a measure of discipline. Neither men nor
women helpers should be permitted to enter the war zone unless they
visit it with a serious purpose and an earnest desire to help. If they
enter in this frame of mind they will have no objection to submitting to
discipline. If they object it is far better for them to stay at home.
It is furthermore apparent that Red Cross workers should be limited to
elderly men of experience or younger men who are physically defective.
In the case of the Y.M.C.A. young and healthy men are required, since
their work is very arduous, the living at times rough to a degree, and
there is not inconsiderable personal risk undertaken by those who are
placed in advanced positions. In national wars every healthy adult is
of great value as a soldier, and it is necessary to see that as few of
such men as possible are utilised in these auxiliary services.
If the arrangements here indicated had been carried into effect, the
work in Egypt would have been much better done and the activities of the
Y.M.C.A. would have prevented a vast amount of trouble and disease. As
it was, the value of the Y.M.C.A. was not apparent to the public at
first, since its activities are not so dramatic as those of the Red
Cross Society, and funds have never been provided for it on anything
like the same scale.
In conclusion, with regard to the Australian Branch British Red Cross,
there is something more to be said. As its name implies, the Australian
Red Cross is a branch of the British Red Cross Society, and yet we have
experienced in Egypt the spectacle of the Egyptian Branch and the
Australian Branch of the same society doing the same work for different
sections of troops engaged in a common cause. There were two Red Cross
stores in Cairo, Australian and British, two stores in Alexandria, and
two in Mudros. Would it not have been much better to amalgamate the two
branches and administer the Red Cross in Egypt as a whole? The
separation served no good material purpose, and whilst by the exercise
of good sense some of the difficulties arising from the dual arrangement
were obviated, yet this evidence of particularism was not advantageous.
Vast quantities of goods were donated to the Australian Troops by the
Comforts Fund, and vast quantities of goods were given to soldiers in
hospitals and convalescent homes by the Australian Branch British Red
Cross. As evidence of soundness of heart on the part of the Australian
public this action was beyond praise, but it is doubtful whether the
methods were the best which might be devised. The generosity of the
public lent itself to some abuse, and soldiers are known to have sold
these goods to Arabs, and employed the cash as they pleased. It is
difficult to draw a healthy mean between strict administration with
proper restriction and lavish administration and abuse. It is doubtful
to me whether it would not better conserve the self-respect of the
soldier and be more dignified if these donations were to cease. In their
place proper facilities might well be substituted for the purchase of
such articles as the soldier required at very low prices. This is the
plan followed by the Y.M.C.A., who never divorce personal service from
any distribution of goods. If the pay of the Australian soldier--which
by the way is the highest in the world--is thought insufficient, it
could be increased by voluntary help conveyed through the proper
official channels. If this system were adopted it would necessitate the
appointment of a Y.M.C.A. and of a Red Cross officer to certain defined
military units, and a well-organised method would at once make its
appearance; in other words, we should substitute sympathetic order and
justice for amateurish enthusiasm.
Does not the necessity for the foregoing criticism indicate our utter
unpreparedness? For if we had possessed a national organisation for
Peace and War, each and all of these problems would have been solved
long ago, and we should have been spared the spectacle of willing
helpers wasting their energy for lack of direction.
PREVENTION OF DISEASE
Surveying the whole campaign, the fundamental fault of the Australian
Army Medical Service was the insufficient attention given to, and stress
laid on, the prevention of disease. Is it not obvious that there should
be a staff of medical officers and orderlies, detached altogether from
any association with the treatment of disease, who should devote
themselves entirely to the problem of prevention? This staff should be
presided over by a Surgeon-General who should be second only in rank to
the Director of Medical Services in the field, and who with his staff
should be armed with authority so far as the taking of steps for the
prevention of disease is concerned. At present the medical officers in
the Australian Medical Service are entrusted with dual functions, the
prevention and the treatment of disease.
So far there has been no Military School for medical officers in
Australia, and until they are properly trained the prevention of disease
will not be as effective as it might be.
In the Royal Army Medical Corps there is a Sanitary Staff, but it does
not seem to me that even this highly trained body occupies the high
position or enjoys the distinction that the value of its services really
demand, and I cannot but think that it would be far better to abolish
the term "sanitary" and to apply to it the term "Prophylactic Staff."
The cure of disease in civil life always attracts the public; it is
dramatic and strikes the attention. The efforts of the men who obviate
the necessity for anything of the kind never receive the same
recognition, because the evil never becomes obvious.
CONDITIONS OF RECRUITS ON ARRIVAL
Captain Lovegrove, A.A.M.C., was appointed Australian Embarkation
Officer at Suez whilst I was in charge. He has contributed the following
article to _The Australian Medical Journal_ relative to the work he did
during his ten months' stay.
"MEDICAL NOTES ON TROOPS FROM AUSTRALIA LANDING AT SUEZ
"BY FREDERICK LOVEGROVE, M.B., Ch.B.(_Melb._), _Captain
A.A.M.C., Australia_
"During ten months' tenure of the unique appointment of Australian
Embarkation Medical Officer, I have had peculiar opportunities of
observing the condition of our soldiers arriving in Egypt.
"The physique of our men has always excited the admiration of the
British and Indian officers who have watched them disembark, and if an
excess of high spirits in the troops has occasionally given an
opportunity for military criticism, from a medical point of view this
sign of robust health is altogether satisfactory.
"The time of the voyage to Egypt from Melbourne averages thirty days;
but, owing to delays at ports of call, many of the troops spend five
weeks or more on board ship. The fact that the death-rate is so low and
the condition of the men so good on arrival speaks highly for the
arrangements on the ships and the watchful care of the medical officers
on transport duty. A few accidents and an occasional case of
appendicitis form the bulk of the cases removed to general wards of Suez
Hospital.
"Infectious disease, however, has occurred on a large number of vessels,
and it has been possible to form some opinion of the epidemics present
in the various camps in Australia, by noting the prevalent type of
infectious disease on ships from different States.
"(1) Influenza has been far and away the most common complaint. Though
some of the patients are still febrile on arrival, and are sent to
hospital here, the epidemic is usually spent before Egypt is reached.
"(2) Pneumonia is occasionally severe, and is usually associated with an
epidemic of influenza. Twelve months ago a certain percentage of cases
developed empyema; for many months now there have been no cases of this
kind.
"(3) Measles has been chiefly found among Victorian troops, and has been
represented every month. South Australia has sent its quota during April
and May. In some cases the epidemic has been wide-spread at first, and
has worked itself out before arrival. In other cases a few men have been
picked out early and isolated, and no epidemic has occurred.
Occasionally a ship has arrived with a large number of cases, evidently
originating after embarkation from some unrecognised case on board.
"(4) Mumps has been represented largely every month. This disease is
practically a perquisite of New South Wales and Queensland troops. The
long incubation period and impossibility of recognising the disease in
an early stage makes a general ship infection the rule, and the
epidemic is usually at its height when the troops arrive here.
"(5) Cerebro-spinal meningitis has not occurred as an epidemic, but has
appeared on the returns every month, with one or two cases. Victoria has
contributed the largest number of cases, except in November and January,
when New South Wales supplied the largest number. Victoria has had a
monopoly for the past four months.
"(6) Enteric fever has been remarkable by its rarity. Ten cases only
have been noted; of which New South Wales contributed six, five from one
ship; Victoria one in each of the months of September, November, and
December; and South Australia one in December. No cases have occurred
this year.
"Chicken-pox, scarlet fever, and roetheln have occasioned no trouble
here. Small-pox, plague, or cholera have not occurred among troops on
Australian transports.
"(7) Venereal disease. While the percentage of troops arriving in Egypt
with venereal disease is not high--the actual figure is 0·75 per
cent.--the total number of effectives withdrawn from combatant duty
owing to this cause is sufficiently large to make the subject one of
importance. In ten months 530 men with gonorrhoea and 90 men with
syphilis have had to go to hospital immediately on arrival. Soft sores
have almost always been cured on the voyage, so that practically all
chancres seen here are syphilitic. By far the greatest number of
syphilitic cases hail from Queensland and New South Wales, and while
gonorrhoea is the main feature of Victorian venereal cases, the two
previously mentioned States take the precedence here also. A rise in
the numbers from Western Australia has lately been noticed. This may
possibly be due to the fact that men from other States found to be
suffering from venereal diseases while crossing the Bight are landed in
Western Australia. There is a general rise in the proportion of syphilis
to gonorrhoea, and this is particularly noticeable among Queensland
troops, where the general ratio of one syphilis to six gonorrhoea is now
more like one to one, and occasionally the cases of gonorrhoea are
outnumbered by syphilis."
HOSPITAL ORGANISATION
With extended experience the views of the writer on the subject of the
organisation of military hospitals have crystallised. There is no doubt
that the commander of a hospital must be a medical practitioner, and
there is no doubt that in all matters relating to his hospital his
authority must be final. In the last resort he must decide whether a
patient is to leave the hospital or to stay; who should be admitted, and
what the treatment should be. In a good organisation he will probably be
very rarely required to express an opinion respecting these matters, but
in the event of a conflict of opinion between say the consulting surgeon
or physician and himself, there can be but one final arbitrament. The
position is defined in the King's Regulations and is endorsed by common
sense. So far as the Registrar is concerned I think that he should be a
medical practitioner, but that in every instance there should be an
assistant registrar with the rank of lieutenant, who should do the whole
of the detailed work connected with the records, and who need not
necessarily be a medical officer. In like manner, the Transport Officer
and the Orderly Officer or Adjutant should be of the same character and
rank. Difficulty, however, arises respecting the personnel of these
non-medical offices. It is clear that, for purposes of discipline, they
should belong to the Army Medical Corps and be under the control of the
officer commanding. In time of war there is no doubt that invalided
combatant officers would do very well, but no combatant officer would
want such a position in time of peace, because there would be no
subsequent career available. To effect a satisfactory solution of the
problem it would be necessary to add to the establishment of a base
hospital three non-medical commissioned officers of the same rank as the
Quartermaster, preferably former Sergt.-Majors who have obtained
commissions and who consequently know the details of hospital
administration thoroughly. There would then be in each base hospital
four non-medical commissioned officers, viz. the Quartermaster, the
Asst. Registrar, the Orderly Officer, and the Transport Officer, and all
would belong to the A.M.C. A hospital suitably staffed on this plan
would run very smoothly.
ASSISTANCE OF ANGLO-EGYPTIANS
Surveying the work of the Australian Army Medical Corps in Egypt, it
does seem to me that sufficient acknowledgment has not been made of the
services rendered and the help given to the Australian sick and wounded
by the British residents in Egypt, who, from their Excellencies Sir
Henry and Lady MacMahon downwards, spared no effort to help wherever
assistance was possible. Very many of the officials employed in the
Egyptian Government service came to the hospitals when the day's work
was over and worked till late in the night, rendering services which
freed the orderlies for other special duty. It was impossible to get
reinforcements with any rapidity, the pressure was enormous, and the
least that can be said is that these ladies and gentlemen are entitled
to respectful and grateful acknowledgment from the people of Australia.
Special acknowledgment also should be made of the sympathetic help given
by the courteous and able officers of the Egyptian State Railways.
I do not think it will be right to close the work without personal
acknowledgment of the exceedingly valuable help given in a time of
crisis by the ladies and gentlemen whose names are attached, and who, at
great inconvenience, came forward at the time when other help was
unobtainable.
No. 1 AUSTRALIAN GENERAL HOSPITAL--HELIOPOLIS PALACE
From its establishment until the opening of No. 2 General Hospital
_Principal Red Cross Visitor_
Mrs. Elgood
_Ward Visitors (daily or several times a week)_
Lady Oakes
Mrs. Abramson
Mrs. Blakeney
Mrs. Frank Watson
Mrs. Boys
Mrs. Madden
Lady Brunyate
Mrs. Perels
Mrs. Dale
Mrs. Mackworth
The Hon. Mrs. Home
Lady Cheetham
Mrs. Everett
Miss Devonshire
Mrs. Teal
Lady Douglas
Mrs. Paxton
Mrs. Fletcher
Mrs. Dunhill
Most valuable assistance was also rendered by Mrs. Travers
Symons and Mrs. W. Jessop.
_Flower Ladies (visiting three times a week)_
Mrs. Hodgson
Mrs. Spong
Miss Marshall
Mrs. Crawley
Mrs. Garrett
Mrs. Spencer Smith
Mrs. Lumley Smith
HELIOPOLIS
From the opening of the No. 2 General Hospital, till end of July
1915
_Principal Visitor_
Mrs. Elgood
_Ward Visitors (daily or several times a week)_
Lady Oakes
Mrs. Waller
Mrs. Sender
Mrs. Fox
Mrs. Summons
Mrs. Maxwell
Miss Mavris
Mr. Dulle
Mr. Schreiber
Major Blakeney
Mrs. Blakeney
Mrs. MacDonald
Mrs. Everett
Mrs. H. Chisholme
The Hon. Mrs. Home
Mrs. Perels
Mrs. Dale
Mrs. Fletcher
Mrs. Spencer Smith
Mrs. Dawnay
Mrs. and Miss Knox
Mrs. and the Misses Spens
Three Ladies from C.M.S.
Mme. and Mlle. de Lancker
Mme. de Rey
Mrs. Dunbar Brunton
Miss Hanauer
Mrs. Watson
Mr. St. Clair
Dr. Grace Russell
Mrs. Adie
Mrs. Wisdom
Mrs. Makeham
Mrs. Bruce
_Organiser of Concerts_
The Countess de Lavison
NO. 1 AUSTRALIAN GENERAL HOSPITAL
_Gentlemen who did Telephone Duty at Heliopolis Palace_
Mr. H. O. Bennett, Kubba Gardens
Mr. G. Brackenbury, late of Palais de Kubba
Mr. L. Billson, Zeitoun
Mr. N. L. Ablett, Helmieh
Mr. A. Abramson, late of Heliopolis
Mr. T. H. Clarke, Zeitoun
Mr. G. R. Tadman, late of Heliopolis
Mr. H. B. May, late of Zeitoun
Mr. A. R. B. Milton, Heliopolis
Mr. S. Fraser, Heliopolis
Mr. R. Lawson, Heliopolis
Mr. M. R. Pattison, Zeitoun
Mr. G. Muller, Kafr el Gamous
Mr. H. E. Gardiner, Kafr el Gamous
Mr. E. Griffith Jones, Mataria
Mr. J. C. Mansfield, Kubba les Bains
Mr. J. K. Parkes, late of Heliopolis
Mr. Hanauer (Senr.), late of Heliopolis
LUNA PARK--SKATING RINK
From opening till middle of July 1915
_Principal Visitor_
Lady Oakes
_Ward Visitors (daily or several times a week)_
Mrs. Spencer Smith
Mrs. Elgood
Mrs. H. Chisholme
Miss Griffiths
Mrs. Wellburn
Mrs. Barry Davies
The Misses Crewe (2)
Mrs. Woodifield
Mrs. Clogstoun
Mrs. Mackworth
Major Blakeney
Mrs. Teasdale Smith
Mrs. Rebett
Miss Christian
Mrs. Knox
Mrs. Parlato
Mme. Yenidimia
Mrs. Bailey
Mrs. Everett
Mrs. Williams
Mr. Blythe
Mrs. Makeham
Mrs. Bruce
Mr. Naggiar
Mr. Airlet
Mrs. Fenwick
_Daily Ward Workers_
Miss Villedieu
Mrs. Addison
Miss Ratzkowski
Mrs. Le Fleming
Mrs. Murray
The Hon. Mrs. Morrison Bell
Mrs. Hibbert
Mrs. and Miss Leathes
Mrs. Sender
Mrs. Walker
Mrs. Fox
Miss Morrison
Miss Pound
Mrs. Wilson
Mlle. Picciotti
Mrs. Fanous
LUNA PARK PAVILION
_Principal Visitor_
Mr. Blythe
_Helpers_
Mr. and Mrs. May, late of Zeitoun
Mr. and Mrs. Bennett, Kubba Gardens
Mr. and Mrs. Micklam, Palais Kubba
Mr. and Mrs. Stopford, Zeitoun
Mr. and Mrs. Ablett, Helmieh
Mr. and Mrs. Levy, Heliopolis
Mr. and Mrs. Hood, late of Kubba Gardens
Mr. and Mrs. Clarke, now at Kubba les Bains
Mrs. T. and Miss Williams, Zeitoun
Mrs. Watkins, late of Zeitoun
Mrs. Hogan, late of Zeitoun
Mrs. Fenwick, Helmieh
Mrs. Tite, Zeitoun
Mr. Goadby, late of Zeitoun
Mr. Brackenbury, late of Palais Kubba
Mr. Poths, now at Kubba les Bains
ATELIER
_Principal Visitor_
Mr. Goadby
_Daily Workers_
Mrs. Goadby
Mrs. and the Misses Spens
Mrs. Dawnay (_Librarian_)
Mrs. Morris
SPORTING CLUB
_Principal Visitor_
Mr. Herbert
_Daily Worker_
Mrs. Eddy (after Nov. 1916)
[The first Inquiry Bureau in Egypt for service in connection
with the Wounded and Missing was established by Mrs. Jessop, of
the Y.M.C.A.]
APPENDIXES
APPENDIX I: TRANSLATION OF GENEVA CONVENTION OF JULY 6, 1906
APPENDIX II: CONVENTION FOR THE ADAPTATION OF THE PRINCIPLES OF
THE GENEVA CONVENTION TO MARITIME WAR
APPENDIX I
CHAPTER I
THE WOUNDED AND SICK
_Article 1_
Officers and soldiers, and other persons officially attached to armies,
shall be respected and taken care of when wounded or sick by the
belligerent in whose power they may be, without distinction of
nationality.
Nevertheless, a belligerent who is compelled to abandon sick or wounded
to the enemy shall, as far as military exigencies permit, leave with
them a portion of his medical _personnel_ and material to contribute to
the care of them.
_Article 2_
Except as regards the treatment to be provided for them in virtue of the
preceding article, the wounded and sick of an army who fall into the
hands of an enemy are prisoners of war, and the general provisions of
international law concerning prisoners are applicable to them.
Belligerents are, however, free to arrange with one another such
exceptions and mitigations with reference to sick and wounded prisoners
as they may judge expedient; in particular, they will be at liberty to
agree--
To restore to one another the wounded left on the field after a battle;
To repatriate any wounded and sick whom they do not wish to retain as
prisoners, after rendering them fit for removal or after recovery;
To hand over to a neutral State, with the latter's consent, the enemy's
wounded and sick to be interned by the neutral State until the end of
hostilities.
_Article 3_
After each engagement the Commander in possession of the field shall
take measures to search for the wounded, and to ensure protection
against pillage and maltreatment both for the wounded and for the dead.
He shall arrange that a careful examination of the bodies is made before
the dead are buried or cremated.
_Article 4_
As early as possible each belligerent shall send to the authorities of
the country or army to which they belong the military identification
marks or tokens found on the dead, and a nominal roll of the wounded or
sick who have been collected by him.
The belligerents shall keep each other mutually informed of any
internments and changes, as well as of admissions into hospital and
deaths among the wounded and sick in their hands. They shall collect all
the articles of personal use, valuables, letters, etc., which are found
on the field of battle or left by the wounded or sick who have died in
the medical establishments or units, in order that such objects may be
transmitted to the persons interested by the authorities of their own
country.
_Article 5_
The competent military authority may appeal to the charitable zeal of
the inhabitants to collect and take care of, under his direction, the
wounded or sick of armies, granting to those who respond to the appeal
special protection and certain immunities.
CHAPTER II
Medical Units and Establishments
_Article 6_
Mobile medical units (that is to say, those which are intended to
accompany armies into the field) and the fixed establishments of the
medical service shall be respected and protected by the belligerents.
_Article 7_
The protection to which medical units and establishments are entitled
ceases if they are made use of to commit acts harmful to the enemy.
_Article 8_
The following facts are not considered to be of a nature to deprive a
medical unit or establishment of the protection guaranteed by Article
6:--
1. That the _personnel_ of the unit or of the establishment is armed,
and that it uses its arms for its own defence or for that of the sick
and wounded under its charge.
2. That in default of armed orderlies the unit or establishment is
guarded by a picquet or by sentinels furnished with an authority in due
form.
3. That weapons and cartridges taken from the wounded and not yet handed
over to the proper department are found in the unit or establishment.
CHAPTER III
PERSONNEL
_Article 9_
The _personnel_ engaged exclusively in the collection, transport, and
treatment of the wounded and the sick, as well as in the administration
of medical units and establishments, and the Chaplains attached to
armies, shall be respected and protected under all circumstances. If
they fall into the hands of the enemy they shall not be treated as
prisoners of war.
These provisions apply to the guard of medical units and establishments
under the circumstances indicated in Article 8 (2).
_Article 10_
The _personnel_ of Voluntary Aid Societies, duly recognised and
authorised by their Government, who may be employed in the medical units
and establishments of armies, is placed on the same footing as the
_personnel_ referred to in the preceding article, provided always that
the first-mentioned _personnel_ shall be subject to military law and
regulations.
Each State shall notify to the other, either in time of peace or at the
commencement of or during the course of hostilities, but in every case
before actually employing them, the names of the societies which it has
authorised, under its responsibility, to render assistance to the
regular medical service of its armies.
_Article 11_
A recognised society of a neutral country can only afford the assistance
of its medical _personnel_ and units to a belligerent with the previous
consent of its own Government and the authorisation of the belligerent
concerned.
A belligerent who accepts such assistance is bound to notify the fact to
his adversary before making any use of it.
_Article 12_
The persons designated in Articles 9, 10, and 11, after they have fallen
into the hands of the enemy, shall continue to carry on their duties
under his direction.
When their assistance is no longer indispensable, they shall be sent
back to their army or to their country at such time and by such route as
may be compatible with military exigencies.
They shall then take with them such effects, instruments, arms, and
horses as are their private property.
_Article 13_
The enemy shall secure to the persons mentioned in Article 9, while in
his hands, the same allowances and the same pay as are granted to the
persons holding the same rank in his own army.
CHAPTER IV
MATERIAL
_Article 14_
If mobile medical units fall into the hands of the enemy they shall
retain their material, including their teams, irrespectively of the
means of transport and the drivers employed.
Nevertheless, the competent military authority shall be free to use the
material for the treatment of the wounded and sick. It shall be restored
under the conditions laid down for the medical _personnel_, and so far
as possible at the same time.
_Article 15_
The buildings and material of fixed establishments remain subject to the
laws of war, but may not be diverted from their purpose so long as they
are necessary for the wounded and the sick.
Nevertheless, the Commanders of troops in the field may dispose of them,
in case of urgent military necessity, provided they make previous
arrangements for the welfare of the wounded and sick who are found
there.
_Article 16_
The material of Voluntary Aid Societies which are admitted to the
privileges of the Convention under the conditions laid down therein is
considered private property, and as such to be respected under all
circumstances, saving only the right of requisition recognised for
belligerents in accordance with the laws and customs of war.
CHAPTER V
CONVOYS OF EVACUATION
_Article 17_
Convoys of evacuation shall be treated like mobile medical units subject
to the following special provisions:--
1. A belligerent intercepting a convoy may break it up if military
exigencies demand, provided he takes charge of the sick and wounded who
are in it.
2. In this case, the obligation to send back the medical _personnel_,
provided for in Article 12, shall be extended to the whole of the
military _personnel_ detailed for the transport or the protection of the
convoy, and furnished with an authority in due form to that effect.
The obligation to restore the medical material, provided for in Article
14, shall apply to railway trains, and boats used in internal
navigation, which are specially arranged for evacuations, as well as to
the material belonging to the medical service for fitting up ordinary
vehicles, trains, and boats.
Military vehicles other than those of the medical service may be
captured with their teams.
The civilian _personnel_ and the various means of transport obtained by
requisition, including railway material and boats used for convoys,
shall be subject to the general rules of international law.
CHAPTER VI
THE DISTINCTIVE EMBLEM
_Article 18_
As a compliment to Switzerland, the heraldic emblem of the red cross on
a white ground, formed by reversing the Federal colours, is retained as
the emblem and distinctive sign of the medical service of armies.
_Article 19_
With the permission of the competent military authority, this emblem
shall be shown on the flags and armlets (_brassards_), as well as on all
the material belonging to the Medical Service.
_Article 20_
The _personnel_ protected in pursuance of Articles 9 (paragraph 1), 10,
and 11 shall wear, fixed to the left arm, an armlet (_brassard_), with a
red cross on a white ground, delivered and stamped by the competent
military authority, and accompanied by a certificate of identity in the
case of persons who are attached to the medical service of armies, but
who have not a military uniform.
_Article 21_
The distinctive flag of the Convention shall only be hoisted over those
medical units and establishments which are entitled to be respected
under the Convention, and with the consent of the military authorities.
It must be accompanied by the national flag of the belligerent to whom
the unit or establishment belongs.
Nevertheless, medical units which have fallen into the hands of the
enemy, so long as they are in that situation, shall not fly any other
flag than that of the Red Cross.
_Article 22_
The medical units belonging to neutral countries which may be authorised
to afford their services under the conditions laid down in Article 11
shall fly, along with the flag of the Convention, the national flag of
the belligerent to whose army they are attached.
The provisions of the second paragraph of the preceding article are
applicable to them.
_Article 23_
The emblem of the red cross on a white ground and the words "Red Cross"
or "Geneva Cross" shall not be used either in time of peace or in time
of war, except to protect or to indicate the medical units and
establishments and the _personnel_ and material protected by the
Convention.
CHAPTER VII
APPLICATION AND CARRYING OUT OF THE CONVENTION
_Article 24_
The provisions of the present Convention are only binding upon the
Contracting Powers in the case of war between two or more of them. These
provisions shall cease to be binding from the moment when one of the
belligerent Powers is not a party to the Convention.
_Article 25_
The Commanders-in-chief of belligerent armies shall arrange the details
for carrying out the preceding articles, as well as for cases not
provided for, in accordance with the instructions of their respective
Governments, and in conformity with the general principles of the
present Convention.
_Article 26_
The Signatory Governments will take the necessary measures to instruct
their troops, especially the _personnel_ protected, in the provisions of
the present Convention, and to bring them to the notice of the civil
population.
CHAPTER VIII
PREVENTION OF ABUSES AND INFRACTIONS
_Article 27_
The Signatory Governments, in countries the legislation of which is not
at present adequate for the purpose, undertake to adopt or to propose to
their legislative bodies such measures as may be necessary to prevent at
all times the employment of the emblem or the name of Red Cross or
Geneva Cross by private individuals or by societies other than those
which are entitled to do so under the present Convention, and in
particular for commercial purposes as a trade-mark or trading mark.
The prohibition of the employment of the emblem or the names in question
shall come into operation from the date fixed by each legislature, and
at the latest five years after the present Convention comes into force.
From that date it shall no longer be lawful to adopt a trade-mark or
trading mark contrary to this prohibition.
_Article 28_
The Signatory Governments also undertake to adopt, or to propose to
their legislative bodies, should their military law be insufficient for
the purpose, the measures necessary for the repression in time of war of
individual acts of pillage and maltreatment of the wounded and sick of
armies, as well as for the punishment, as an unlawful employment of
military insignia, of the improper use of the Red Cross flag and armlet
(_brassard_) by officers and soldiers or private individuals not
protected by the present Convention.
They shall communicate to one another, through the Swiss Federal
Council, the provisions relative to these measures of repression at the
latest within five years from the ratification of the present
Convention.
GENERAL PROVISIONS
_Article 29_
The present Convention shall be ratified as soon as possible. The
ratifications shall be deposited at Berne.
When each ratification is deposited a _procès verbal_ shall be drawn up,
and a copy thereof certified as correct shall be forwarded through the
diplomatic channel to all the Contracting Powers.
_Article 30_
The present Convention shall come into force for each Power six months
after the date of the deposit of its ratification.
_Article 31_
The present Convention, duly ratified, shall replace the Convention of
August 22nd, 1864, in relations between the Contracting States. The
Convention of 1864 remains in force between such of the parties who
signed it who may not likewise ratify the present Convention.
_Article 32_
The present Convention may be signed until December 31st next by the
Powers represented at the Conference, which was opened at Geneva on June
11, 1906, as also by the Powers, not represented at that Conference,
which signed the Convention of 1864.
Such of the aforesaid Powers as shall have not signed the present
Convention by December 31st, 1906, shall remain free to accede to it
subsequently. They shall notify their accession by means of a written
communication addressed to the Swiss Federal Council, and communicated
by the latter to all the Contracting Powers.
Other Powers may apply to accede in the same manner, but their request
shall only take effect if within a period of one year from the
notification of it to the Federal Council no objection to it reaches the
Council from any of the Contracting Powers.
_Article 33_
Each of the Contracting Powers shall be at liberty to denounce the
present Convention. The denunciation shall not take effect until one
year after the written notification of it has reached the Swiss Federal
Council. The Council shall immediately communicate the notification to
all the other Contracting Parties.
The denunciation shall only affect the Power which has notified it.
APPENDIX II
His Majesty the German Emperor, King of Prussia; the President of the
United States of America; the President of the Argentine Republic; His
Majesty the Emperor of Austria, King of Bohemia, etc., and Apostolic
King of Hungary; His Majesty the King of the Belgians; the President of
the Republic of Bolivia; the President of the Republic of the United
States of Brazil; His Royal Highness the Prince of Bulgaria; the
President of the Republic of Chile; His Majesty the Emperor of China;
the President of the Republic of Colombia; the Provisional Governor of
the Republic of Cuba; His Majesty the King of Denmark; the President of
the Dominican Republic; the President of the Republic of Ecuador; His
Majesty the King of Spain; the President of the French Republic; His
Majesty the King of the United Kingdom of Great Britain and Ireland and
of the British Dominions beyond the Seas, Emperor of India; His Majesty
the King of the Hellenes; the President of the Republic of Guatemala;
the President of the Republic of Haiti; His Majesty the King of Italy;
His Majesty the Emperor of Japan; His Royal Highness the Grand Duke of
Luxemburg, Duke of Nassau; the President of the United States of Mexico;
His Royal Highness the Prince of Montenegro; the President of the
Republic of Nicaragua; His Majesty the King of Norway; the President of
the Republic of Panama; the President of the Republic of Paraguay; Her
Majesty the Queen of the Netherlands; the President of the Republic of
Peru; His Imperial Majesty the Shah of Persia; His Majesty the King of
Portugal and of the Algarves, etc.; His Majesty the King of Roumania;
His Majesty the Emperor of All the Russias; the President of the
Republic of Salvador; His Majesty the King of Serbia; His Majesty the
King of Siam; His Majesty the King of Sweden; the Swiss Federal Council;
His Majesty the Emperor of the Ottomans; the President of the Oriental
Republic of Uruguay; the President of the United States of Venezuela:
Animated alike by the desire to diminish, as far as depends on them, the
inevitable evils of war; and
Wishing with this object to adapt to maritime war the principles of the
Geneva Convention of July 6, 1906:
Have resolved to conclude a Convention for the purpose of revising the
Convention of July 29, 1899, relative to this question, and have
appointed as their Plenipotentiaries, that is to say:
[Names of Plenipotentiaries.]
Who, after having deposited their full powers, found to be in good and
due form, have agreed upon the following provisions:--
_Article 1_
Military hospital-ships, that is to say, ships constructed or adapted by
States for the particular and sole purpose of aiding the sick, wounded,
and shipwrecked, the names of which have been communicated to the
belligerent Powers at the commencement or during the course of
hostilities, and in any case before they are employed, shall be
respected, and may not be captured while hostilities last.
Such ships, moreover, are not on the same footing as war-ships as
regards their stay in a neutral port.
_Article 2_
Hospital-ships, equipped wholly or in part at the expense of private
individuals or officially recognised relief societies, shall likewise be
respected and exempt from capture, if the belligerent Power to which
they belong has given them an official commission and has notified their
names to the hostile Power at the commencement of or during hostilities,
and in any case before they are employed.
Such ships shall be provided with a certificate from the proper
authorities declaring that the vessels have been under their control
while fitting out and on final departure.
_Article 3_
Hospital-ships, equipped wholly or in part at the expense of private
individuals or officially recognised societies of neutral countries,
shall be respected and exempt from capture, on condition that they are
placed under the orders of one of the belligerents, with the previous
consent of their own Government and with the authorisation of the
belligerent himself, and on condition also that the latter has notified
their name to his adversary at the commencement of or during
hostilities, and in any case before they are employed.
_Article 4_
The ships mentioned in Articles 1, 2, and 3 shall afford relief and
assistance to the wounded, sick, and shipwrecked of the belligerents
without distinction of nationality.
The Governments undertake not to use these ships for any military
purpose.
Such vessels must in no wise hamper the movements of the combatants.
During and after an engagement they will act at their own risk and
peril.
The belligerents shall have the right to control and search them; they
may refuse to help them, order them off, make them take a certain
course, and put a Commissioner on board; they may even detain them, if
the situation is such as to require it.
The belligerents shall, as far as possible, enter in the log of the
hospital-ships the orders which they give them.
_Article 5_
Military hospital-ships shall be distinguished by being painted white
outside with a horizontal band of green about a metre and a half in
breadth.
The ships mentioned in Articles 2 and 3 shall be distinguished by being
painted white outside with a horizontal band of red about a metre and a
half in breadth.
The boats of the said ships, as also small craft which may be used for
hospital work, shall be distinguished by similar painting.
All hospital-ships shall make themselves known by hoisting, with their
national flag, the white flag with a red cross provided by the Geneva
Convention, and further, if they belong to a neutral State, by flying
at the mainmast the national flag of the belligerent under whose orders
they are placed.
Hospital-ships which are detained under Article 4 by the enemy must haul
down the national flag of the belligerent to whom they belong.
The ships and boats above mentioned which wish to ensure by night the
freedom from interference to which they are entitled, must, subject to
the assent of the belligerent they are accompanying, take the necessary
measures to render their special painting sufficiently plain.
_Article 6_
The distinguishing signs referred to in Article 5 shall only be used,
whether in peace or war, for protecting or indicating the ships therein
mentioned.
_Article 7_
In the case of a fight on board a war-ship, the sick-bays shall be
respected and spared as far as possible.
The said sick-bays and the _matériel_ belonging to them remain subject
to the laws of war; they cannot, however, be used for any purpose other
than that for which they were originally intended, so long as they are
required for the sick and wounded.
The commander into whose power they have fallen may, however, if the
military situation requires it, apply them to other purposes, after
seeing that the sick and wounded on board are properly provided for.
_Article 8_
Hospital-ships and sick-bays of vessels are no longer entitled to
protection if they are employed for the purpose of injuring the enemy.
The fact of the staff of the said ships and sick-bays being armed for
maintaining order and for defending the sick and wounded, and the
presence of wireless telegraphy apparatus on board, are not sufficient
reasons for withdrawing protection.
_Article 9_
Belligerents may appeal to the charity of the commanders of neutral
merchant-ships, yachts, or boats to take the sick and wounded on board
and tend them.
Vessels responding to this appeal, and also vessels which may have of
their own accord rescued sick, wounded, or shipwrecked men, shall enjoy
special protection and certain immunities. In no case may they be
captured for the sole reason of having such persons on board; but,
subject to any undertaking that may have been given to them, they remain
liable to capture for any violations of neutrality they may have
committed.
_Article 10_
The religious, medical, and hospital staff of any captured ship is
inviolable, and its members may not be made prisoners of war. On leaving
the ship they are entitled to remove their own private belongings and
surgical instruments.
They shall continue to discharge their duties so far as necessary, and
can afterwards leave, when the Commander-in-Chief considers it
permissible.
Belligerents must guarantee to the said staff, while in their hands, the
same allowances and pay as are given to the staff of corresponding rank
in their own navy.
_Article 11_
Sick or wounded sailors, soldiers on board, or other persons officially
attached to fleets or armies, whatever their nationality, shall be
respected and tended by the captors.
_Article 12_
Any war-ship belonging to a belligerent may demand the surrender of
sick, wounded, or shipwrecked men on board military hospital-ships,
hospital-ships belonging to relief societies or to private individuals,
merchant-ships, yachts, or boats, whatever the nationality of such
vessels.
_Article 13_
If sick, wounded, or shipwrecked persons are taken on board a neutral
war-ship, precaution must be taken, so far as possible, that they do not
again take part in the operations of the war.
_Article 14_
The sick, wounded, or shipwrecked of one of the belligerents who fall
into the power of the other belligerent are prisoners of war. The captor
must decide, according to circumstances, whether to keep them, send them
to a port of his own country, to a neutral port, or even to an enemy
port. In this last case, prisoners thus repatriated may not serve again
while the war lasts.
_Article 15_
The sick, wounded, or shipwrecked, who are landed at a neutral port with
the consent of the local authorities, must, in default of arrangement to
the contrary between the neutral State and the belligerent States, be
guarded by the neutral States so as to prevent them from again taking
part in the operations of the war.
The expenses of tending them in hospital and interning them shall be
borne by the State to which the shipwrecked, sick, or wounded persons
belong.
_Article 16_
After every engagement, the two belligerents shall, so far as military
interests permit, take steps to look for the sick, wounded, and
shipwrecked, and to protect them, as well as the dead, against pillage
and improper treatment.
They shall see that the burial, whether by land or sea, or cremation of
the dead shall be preceded by a careful examination of the corpse.
_Article 17_
Each belligerent shall send, as early as possible, the military marks or
documents of identity found on the dead and a list of the names of the
sick and wounded picked up by him to the authorities of their country,
navy, or army.
The belligerents shall keep each other informed as to internments and
transfers as well as to the admissions into hospital and deaths which
have occurred among the sick and wounded in their hands. They shall
collect all the objects of personal use, valuables, letters, etc., which
may be found in the captured ships, or which may have been left by the
sick or wounded who died in hospital, in order to have them forwarded to
the persons concerned by the authorities of their own country.
_Article 18_
The provisions of the present Convention do not apply except between
Contracting Powers, and then only if all the belligerents are parties to
the Convention.
_Article 19_
The Commander-in-Chief of the belligerent fleets shall give detailed
directions for carrying out the preceding Articles and for meeting cases
not therein provided for, in accordance with the instructions of their
respective Governments and in conformity with the general principles of
the present Convention.
_Article 20_
The Signatory Powers shall take the necessary steps in order to bring
the provisions of the present Convention to the knowledge of their naval
forces, and especially of the members entitled thereunder to immunity,
and to make them known to the public.
_Article 21_
The Signatory Powers likewise undertake to enact or to propose to their
Legislatures, if their criminal laws are inadequate, the measures
necessary for checking in time of war individual acts of pillage and
ill-treatment in respect to the sick and wounded in the fleet, as well
as for punishing as an unjustifiable adoption of naval or military
marks, the unauthorised use of the distinctive marks mentioned in
Article 5, by vessels not protected by the present Convention.
They shall communicate to each other, through the Netherland Government,
the enactments for preventing such acts at the latest within five years
of the ratification of the present Convention.
_Article 22_
In the case of operations of war between the land and sea forces of
belligerents, the provisions of the present Convention are only
applicable to the forces on board ship.
_Article 23_
The present Convention shall be ratified as soon as possible.
The ratifications shall be deposited at The Hague.
The first deposit of ratifications shall be recorded in a Protocol
signed by the Representatives of the Powers which take part therein and
by the Netherland Minister for Foreign Affairs.
The subsequent deposits of ratifications shall be made by means of a
written notification, addressed to the Netherland Government and
accompanied by the instrument of ratification.
A duly certified copy of the Protocol relating to the first deposit of
ratifications, of the notifications mentioned in the preceding
paragraph, and of the instruments of ratification, shall be immediately
sent by the Netherland Government through the diplomatic channel to the
Powers invited to the Second Peace Conference, as well as to the other
Powers which have acceded to the Convention. The said Government shall,
in the cases contemplated in the preceding paragraph, inform them at the
same time of the date on which it received the notification.
_Article 24_
Non-Signatory Powers which have accepted the Geneva Convention of July
6, 1906, may accede to the present Convention.
A Power which desires to accede notifies its intention in writing to the
Netherland Government, forwarding to it the act of accession, which
shall be deposited in the archives of the said Government.
The said Government shall immediately forward to all the other Powers a
duly certified copy of the notification, as well as of the act of
accession, mentioning the date on which it received the notification.
_Article 25_
The present Convention, duly ratified, shall replace, as between
Contracting Powers, the Convention of July 29, 1899, for the adaptation
to naval warfare of the principles of the Geneva Convention.
The Convention of 1899 remains in force as between the Powers which
signed it but which do not also ratify the present Convention.
_Article 26_
The present Convention shall take effect, in the case of the Powers
which were parties to the first deposit of ratifications, sixty days
after the date of the Protocol recording such deposit, and, in the case
of the Powers which shall ratify subsequently or which shall accede,
sixty days after the notification of their ratification or of their
accession has been received by the Netherland Government.
_Article 27_
In the event of one of the Contracting Powers wishing to denounce the
present Convention, the denunciation shall be notified in writing to the
Netherland Government, which shall immediately communicate a duly
certified copy of the notification to all the other Powers, informing
them of the date on which it was received.
The denunciation shall only operate in respect of the denouncing Power,
and only on the expiry of one year after the notification has reached
the Netherland Government.
_Article 28_
A register kept by the Netherland Ministry for Foreign Affairs shall
record the date of the deposit of ratifications effected in virtue of
Article 23, paragraphs 3 and 4, as well as the date on which the
notifications of accession (Article 24, paragraph 2) or of denunciation
(Article 27, paragraph 1) have been received.
Each Contracting Power is entitled to have access to this register and
to be supplied with duly certified extracts from it.
In faith whereof the Plenipotentiaries have appended their signatures to
the present Convention.
Done at The Hague, October 18, 1907, in a single original, which shall
remain deposited in the archives of the Netherland Government, and of
which duly certified copies shall be sent, through the diplomatic
channel, to the Powers invited to the Second Peace Conference.
INDEX
Aboukir Bay, 40
Administration, Army Medical, 61
Alderson, Mr., 40
Ambulance trains, 47-48
Antityphoid inoculation, 18
Arab servants, 41
Arbitration Commission, 39
Area medical officers, 3
Arrival of wounded in crisis, 43
Atelier, the (_see also_ Hospitals, Auxiliary), 36-51
Aural diseases, 92-99
Australia, a clean, 118
Australia, a white, 118
Australian Army Medical Reserve, 4
Australian Government, the, 29, 30, 40, 52, 91
Australian Intermediate Base, 29
Baird, Sir Alexander, 39, 142
Barrett, Lt.-Col. J. W., 23, 29, 39, 73, 92-98, 120, 138 _et seq._
Base hospitals, 1, 2
Base medical store, 79
Beds, palm wood, 29, 30
Bilharzia, 99
Birdwood, General Sir William, 89, 115-121, 154, 199
Boards, Medical, on invalids, 70
Bridges, the late General Sir Walter, 6, 89, 115
Bronchitis, 6, 86
Brookes, Mr. Norman, 144
Brown, Major, 52
Buildings, acquisition, 26
Burials of Australians in Cairo, 103
Camp, Convalescent, Zeitoun, 57
Casino, the, Heliopolis (_see_ Hospitals, Auxiliary), 28
Casualties, table showing, 90
Casualty Clearing Station, 8
Cecil, Lord Edward, 142
Chaplains, value of, 194
Cholera, 38, 106-109
Climate, the Egyptian, 58, 59, 104, 105
The Khamsin, 26, 58, 59, 104
Wet Bulb records, 58-59
Clubs, Soldiers' (_see_ Soldiers' Clubs and Red Cross), 125, 133
Commander-in-Chief (G.O.C.-in-C.) (_see also_ General
Sir John Maxwell), 39, 106, 196
Commissioners, Australian Red Cross, 144
Compulsory military training, 3, 4
Consultants, 192
Cook, Mr. Joseph, 5
Crisis, the, 35, 60
Cuscaden, Colonel, 6
Dardanelles, 27
Deaths,
No. 1 Australian General Hospital, 110
No. 2 Australian General Hospital, 111
Dentists, 192, 193
D.G.M.S. Australia, 6
Discipline, 61-65
Diseases, Infectious, 109
Report on extent of, 87-90
Disinfection, recruits' clothing, 98
D.M.S. Egypt (_see also_ Surgeon-General Ford), 23, 25, 26, 27, 30,
42, 50, 87, 88, 125, 141, 167, 205
Dunn, Captain, 149
Dysentery, 99, 109
Elgood, Mrs., work of, 155, 180
Enlistment of the unfit, 90, 91
Fergusson, Her Excellency Lady Helen Munro, 137, 138
Fetherston, Colonel, 6
Fisher, Mr. Andrew, 5
Flies, cause of disease, 209
Fly campaign (1916), 207
The house, 99-103
Traps, 208
Ford, Surgeon-General (_see also_ D.M.S. Egypt), 21, 28, 73, 101
Funds, Multiplicity of, 219-224
Garages, 42
Geneva Convention, 13, 14, 18, and Appendix I
Gordon House, 39
"Grouser," the, 196
Hospital organisation, 229-230
Hospitals:
Auxiliary Australian, closure, 206
Base, 8
No. 1 Stationary, 8, 27
No. 2 Stationary, 8, 27
No. 1 Australian General:
Causes of death in, 110
Chronology of, 40-41
Closure of, 206
Description of building, 21-23
Difficulties in recruiting, 8, 9
Expansion, 25, 35
Finance arrangements between Governments, 60, 61
Growth of, 53
Ice chests, 105
Lack of reinforcements, 38
Number of cases admitted, 53-54
Policy of expansion, 41
Result of expansion, 38
Staff available, 44, 45-46, 47
No. 2 Australian General, 35, 111
Closure of, 206
No. 3 Australian, closure, 207
Venereal Diseases, Abbassia, 27, 28
Convalescent, 35, 59
Al Hayat, Helouan, 35, 57, 59, 204
Catering at, 51
Grand Hotel, Helouan, 37
Montazah (_see also_ Red Cross), 37, 59
Ras el Tin, 36, 59
Zeitoun Camp, 59
Auxiliary, 36, 41, 49-52;
made independent, 53
Infectious Diseases, Abbassia, 37-52
Infectious Diseases, Choubra, 37
Military, proposed reforms, 189 _et seq._
Australian, evils of dual control, 204
Infectious Diseases Camp, 25, 26
Invalids, transport of, 69-76
Jackson, Stonewall, 64-65
Japan, Emperor of, 121
Jessop, Mr., work of (_see_ Y.M.C.A. and Red Cross), 133
Kendrew, Colonel, work of, 194
Kitchener, Lord, 116, 118
Knox, Mr. Adrian, 144
_Kyarra_, voyage of, 13-18
As hospital carrier, 78
Decomposing food, 16
Explanation of defects, 18
Overcrowding of, 15
Ptomaine poisoning, 15
Sanitation of, 15
Wet decks, 16
Lemnos, 105
Lessons, Russo-Japanese War, 7
Lines of Communication Medical Units, 6
Local purchase orders, 97
Luna Park (_see also_ Hospitals, Auxiliary), 27, 28, 49-51, 54
Pavilion, 30
Rink, 38
Success of hospital, 207
Maadi, 21, 22
Mackenzie, Captain, 22, 111
MacMahon, His Excellency Sir Henry, 126, 142, 143, 144, 167, 199
Her Excellency Lady, 40, 168, 169
Malingerers, 97
Manifold, Colonel, 76, 106
Martin, Lt.-Col., 14, 143
Masseurs, need of, 194
Maxwell, General Sir John, 116, 123, 125, 167
Measles, 6, 97-99
Medical organisation in Egypt, 106
Reserve, a Junior, 54
Students, enlistment of, 10
Mena House and Hospital, 6, 21, 24, 35, 43
Methods of organising hospitals, 39
Morality in Cairo, 123, 124
Mortality low in Cairo, 103, 104
Mortality in transit, 6
In camp in Australia, 7
Motor Ambulances, 41-43
Transport of sick, 60
"Muddling through," 205
Mudros, 27
New Zealand sick and wounded,
British Military Hospital, Citadel, Cairo, 22
Egyptian Army Hospital, Abbassia, 22
Nurses' Rest Homes, 40
Oculists, 24
Ophthalmic work, 92-97
Palace of Prince Ibrahim Khalim, 39
Pneumonia, 6, 86
Port Said, 21
Prevention of disease:
Prophylactic staff, 225
Lack of Australian Military School, 225
Prophylactic officer, 193
Prophylaxis, 83
Ptomaine poisoning, 6, 15, 103
Recruits' condition on arrival, 226
Red Cross, 37, 39, 42, 48, 50-53, 59, 77, 79, 125, 133
Brown's Census (Major), 172-174
Bureau of Inquiry, 155
Chapter on, 137 et seq.
Colonel Onslow's letter, 149-150
Creation of Australian Branch, 137
Difficulties at Mudros, 154
Distribution of goods, 152-153, 159-168
Elgood's (Mrs.) help, 155
Goods for 1st A.G.H., 10
Injudicious help, 181
Japanese methods, 180
Jessop (Mr.), help of, 169
Money distribution, 147-148
Montazah, 156, 157
Motor transport, 157, 158
Nurses' Rest Homes, 169
Policy, 169, 170
Purchase of goods, 156
Ras el Tin, 35
Soldiers' Clubs, 166-167
Store, 148
Trains for invalids, 166
Verses (Malines), 174-176
Wanted, a policy, 177-182
Red Cross Society:
Articles supplied by, 212-216
Functions of (Sir H. MacMahon), 210-212
Lists of articles, 212-216
Many changes in organisation, 217
Reformed methods requisite, 218
Red-Tape, 197
Request by Imperial Government for medical units, 8
Robson, Mayo-, Colonel, 201
Ryan, Colonel Charles, 4, 6, 51
Savoy Hotel, 41
Sellheim, Brigadier-General, 29, 30, 31, 116, 142, 196
Services of Anglo-Egyptians, 230-34
Shepheard's Hotel, 41
Ships, Hospital, 78, 79
Smith, Ramsay, Lt.-Col., Introduction, 23, 29, 141
Soldier's Clubs (_see also_ Clubs and Red Cross), 35, 51, 65, 125, 133
Conduct of, 115-118
Warning to, 119
Specialists, lack of, 192
Oculist and aurist, 10
Radiographer, 10
Spectacle maker requisite, 97
Spens, General, 120
Sporting Club Hospital, 36, 51
Springthorpe, Lt.-Col., 143
Staff, erratic changes of, 197-199
Stomach ache, Egyptian, 105
Suez Waiting Camp, 77
Sultan, H.H. the, 199
Table showing number invalided to Australia, 80
Throat diseases, 92-97
Thomson, Sir Courtauld, 143, 201, 205
Train to Heliopolis, 30
Transport to Australia, 77-79
Wounded to Suez, 79-81
Wounded by sea, 77
Treves, Sir Frederick, 200, 201
Venereal diseases:
Camp, 25-26
Conference on, 129 _et seq._
Essence of problem, 127
Length of stay of cases, 90
Policy, 128, 129
Prevalence of in 1916, 209
Prevalence of in arrivals, 228
Prophylaxis, 124, 125
Removal from Egypt, 121, 122
Wassermann tests, 128
Watson, Captain, 128
Watson, Major, 111
Williams, Surgeon-General, 3, 4, 6, 25, 29, 30, 31, 41, 42, 77,
86, 90, 101, 129, 139 _et seq._
Women, employment of, in hospitals, 191
Y.M.C.A., 37, 50, 65, 125, 133
Y.M.C.A. organisation and work, 209-210, 218-224
Yuille, Captain Max, 141, 149
Postscript, 206
Appendix I., 237
" II., 246
H. K. LEWIS & CO. LTD.
136 GOWER STREET, LONDON, W.C.1
AND PRINTED BY HAZELL, WATSON & VINEY, LD.
LONDON AND AYLESBURY.
Transcriber's Notes
Obvious punctuation errors repaired.
Some numbers in the tables are mistaken but have not been changed.
P. 35: "late" changed to "date" (at a later date became capable).
P. 44: "elequent" changed to "eloquent" (bore eloquent testimony).
P. 182: "P. S. DEANE" changed to "P. E. DEANE".
P. 258: Index entry for "Hospitals: Convalescent, Al Hayat, Helouan"
changed from "304" to "204".
P. 259: Index entry for "Transport to Australia, Wounded to Suez"
changed from "79-61" to "79-81".
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