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.