The fly problem was one of the most serious the army had to face. The

passage of a dysenteric stool by a man who is really ill was often

followed by the entry into his anus of flies before an attendant had

time to intervene. Each of these flies might then become a source of

infection and had only to light on a piece of food, cooked or uncooked,

to cause further damage.

CIRCULAR ISSUED BY THE OFFICER COMMANDING THE HOSPITAL

_Destruction and Prevention of Flies_

_Outside._

1. No rubbish heaps will be allowed.

2. All manure heaps shall be sprayed twice a week with sulphate

of iron--2 lb. to 1 gallon of water.

3. All food in the Arab quarters shall be kept in a closed

cupboard.

4. All rubbish boxes and open receptacles shall be removed from

the premises and neighbourhood.

5. No receptacles other than iron tins with lids kept closed

will be allowed to be used for refuse.

6. Every place on which garbage has been exposed shall be

freely sprinkled with chloriated lime.

_Wards._

1. All food and receptacles for food shall be kept constantly

covered.

2. All spit-cups shall be kept covered.

3. All remains of food shall be removed at once to receptacles

which are to be kept covered completely and constantly except

when uncovered necessarily to receive waste materials.

4. Sisters-in-Charge shall use a liberal quantity of fly

papers. Surgical soiled dressings shall be placed in special

bins which shall be kept covered.

_Kitchen and Mess Rooms._

1. All food shall be kept locked up or completely covered.

2. All remains of food shall be treated as in the wards. The

responsible officer shall use a liberal supply of flat or

hanging fly papers.

It need hardly be said that the enforcement of even these simple

precautions is more difficult than giving the order.

A good sanitary officer, however, acting on these directions, can and

did reduce the fly danger to small proportions. The flies were never

exterminated, but were kept well under. The least slackness, however,

ended in their rapid reappearance. As they are in all probability the

principal cause of the gastro-intestinal infections, the matter is one

of the first importance.

Typhoid fever made its appearance, and a proper statistical

investigation should be made later on to show the extent of the damage

done. The general impression respecting the result of the inoculation to

which all the troops were subjected was that the disease was not so

frequent and certainly not nearly so fatal as it otherwise would have

been. Deaths were few.

The men had not been inoculated against paratyphoid, so that exact

conclusions will be difficult to draw even when figures become

available.

Many people suffered from Egyptian stomach ache, a form of disease which

is as unpleasant as it is exhausting. It manifests itself by repeated

attacks of colicky pain, apparently usually associated with the colon.

The severity of the pains is remarkable, and the persistent recurrence

speedily ends in a considerable degree of exhaustion. It is almost

certainly due to food infection.

It is obvious that the business of a sanitary medical officer is not

merely to inspect buildings and kitchens, but to spend an hour or two a

day in the kitchen quietly watching the preparation of the food and

giving the necessary instruction and supervision to those who are

preparing it. The inefficiency caused by food infections has probably

done more harm than many battles. In the camps similar troubles

occurred. By reason of the lack of cold storage and the high

temperature, rotten food was not uncommon, and caused outbreaks of

incapacitating diarrhoea and ptomaine poisoning.

When, however, the problem is surveyed dispassionately, the remarkable

feature of the work at Heliopolis and in Cairo was the low mortality, as

the following table will show:

BURIALS IN OLD CEMETERY, CAIRO

_From Arrival of Australians in Egypt, December 5, 1914, to August 14,

1915_

British Imperial Force 77

Australian Imperial Force 155

New Zealand Force 50

In view of this extraordinarily low mortality, it is interesting to

comment on human intellectual frailty. It was said that the hospitals

were septic, that operations of election could not be performed with

safety, that the climate was particularly dangerous, and so forth. One

letter which reached us made reference to hundreds of deaths of brave

fellows due to faulty camp and hospital conditions. Yet here is the fact

recorded that the total deaths in Cairo amongst Australians from disease

and wounds to August 14 were only 155. All men tend to generalise on

insufficient instances, and the tendency in this case was aggravated by

some physical discomfort experienced by the generalisers throughout an

unusually warm summer--a discomfort accentuated by overwork and a

conscientious devotion to duty under trying conditions.

THE EGYPTIAN CLIMATE AGAIN

Dealing with the surgical side of the matter, nothing was commoner at

one time than to hear the statement made that owing to the hot weather

septic infections were common, that wounds did not heal as they should

in Egypt, and that it was not a suitable place to which wounded men

should be sent. While quite agreeing with the critics that a cool

climate is always preferable to a hot one, it may be remarked that in

the first place summer in Egypt, apart from the khamsin, is not

excessively hot. The khamsin blows for a certain number of days in

April, May, and the first half of June. The temperature may rise to 112°

or more. The wind blows with a fiery blast, and there is no doubt it is

exceedingly trying. But if buildings are shut up early in the morning

and opened at night, even the khamsin may be made tolerable. After the

middle of June, however, there is very little wind. One day is very

like another. The midday temperature is from 90° to 95° Dry Bulb, and

the nights perhaps 65° to 70° Dry Bulb. The Wet Bulb temperatures are

set out in the table previously referred to.

For the most part men slept in nothing but pyjamas. No sheet is wanted

until towards the end of August. Whilst it is not pleasant to wake in

the mornings in a lather, nevertheless, if a practical and cold-blooded

examination be made of the facts, the result shows nothing but

discomfort.

Grave septic diseases did not occur. The hospitals were perfectly clean,

and at Luna Park in particular we have the testimony of Colonel Ryan

that the wounds healed by first intention and that the cases did

excellently.

As the garrison of Egypt was a very large one, and as Australian troops

were continually pouring into it, it was impracticable even if it had

been necessary to take the patients anywhere else. The islands of Lemnos

and Imbros were far less suitable even for those who had been injured at

Gallipoli, and apart from the inconvenience caused by the heat there was

no reasonable ground for complaint in Egypt. Furthermore the heat is not

tropical. It is subtropical, as the Wet Bulb temperatures indicate.

In the First Australian General Hospital every care was taken to

minimise the inconvenience; a very large number of excellent ice chests

were purchased, an enormous quantity of ice was used, and the necessary

steps thus taken to diminish the amount of food decomposition and

prevent ptomaine poisoning. Fans and punkahs were used, and the nights

were quite tolerable.

MEDICAL ORGANISATION IN EGYPT

When the Australian forces pass three miles from Australian shores they

cease, at all events technically, to be under Australian control, and

pass under the control of the Commander-in-Chief. On arrival in Egypt

they passed under the control of General Sir John Maxwell,

G.O.C.-in-Chief, Egypt. The medical section passed under the command of

the Director of Medical Services, Surgeon-General Ford. The D.M.S.

Australian Imperial Force, Surgeon-General Williams, arrived in Egypt in

February and was placed on the staff of General Ford to assist in

managing these units. He left for London on duty on April 25, and one of

us (J. W. B.) was appointed A.D.M.S. for the Australian Force in Egypt

on the staff of General Ford. Later, Colonel Manifold, I.M.S., was

appointed D.D.M.S. for Australian and other medical units. Thus the

Australian medical units were under the same command as New Zealand or

British units, but with separate intermediaries.

THE RISK OF CHOLERA

In view of the risk of cholera, the following note by Dr. Armand Ruffer,

C.M.G., President of the Sanitary, Maritime and Quarantine Council of

Egypt, Alexandria, was issued and, later on, inoculation was practised

on an extensive scale.

DR. RUFFER'S VIEWS ON CHOLERA

(Report begins) "The first point is that although, in many epidemics,

cholera has been a water-borne disease, yet a severe epidemic may occur

without any general infection of the water supply. This was clearly the

case in the last epidemic in Alexandria. Attention to the water supply,

therefore, may not altogether prevent an epidemic. The second point is

that the vibrio of cholera may be present in a virulent condition in

people showing no, or very slight symptoms of cholera, _e.g._ people

with slight diarrhoea, etc.

The segregation of actual cases of cholera, therefore, is not likely to

be followed by any degree of success, because this measure would not

touch carriers or mild cases, unless orders were given to consider as

contacts all foreign foes, and all soldiers who have been in contact

with them. This is clearly impossible.

There cannot be any reasonable doubt, therefore, that if the Turkish

army becomes infected with cholera, the British Army will undoubtedly

become infected also.

Undoubtedly inoculation is the cheapest and quickest way of protection

of the troops, provided this process confers immunity against cholera.

It is very difficult to estimate accurately the protection given by

inoculation against cholera. My impression from reading the literature

on the subject is that: (1) The inoculations must be done at least

twice. (2) The inoculations, if properly made, are harmless as a rule.

(3) The inoculations confer a certain protection against cholera. I may

add that I arrived at this opinion before the war, when the French

editors, Messrs. Masson & Co., asked me to write the article "Cholera"

for the French standard textbook on pathology. My opinion was therefore

quite unprejudiced by the present circumstances.

The cholera inoculations were harmless _as a rule_; that is, _they were

not always harmless_. Savas has described certain cases of _fulminating

cholera_ amongst people inoculated _during the progress of an epidemic_.

In my opinion, the people so affected were in the period of incubation

when they were inoculated, and the operation gave an extra stimulus, so

to speak, to the dormant vibrio. One knows that, experimentally, a small

dose of toxin, given immediately after or before the inoculation of the

microorganism producing the toxin, renders this microorganism more

virulent.

The conclusion to be drawn is that inoculations should be carried out

before cholera breaks out.

I am afraid I know of no certain facts to guide me in estimating the

length of the period of immunity produced by inoculations. Judging by

analogy, I should say that it is certainly not less than six months,

that it, almost certainly, lasts for one year, and very probably lasts

far longer.

I understand that 90,000 doses of cholera vaccine have been sent from

London. I take it that the inoculation material has been standardised

and its effects investigated, but, in any case, I consider that a few

_very carefully performed_ experiments should be undertaken at once in

Egypt, in order to make sure of the exact method of administration to be

adopted under present conditions.

Probably, a good deal may be done by the timely exhibition of drugs,

such as phenacetin, etc., to mitigate the more or less unpleasant

effects of preventive inoculation.

As I am on this subject, may I point out the necessity of establishing

at the front a laboratory for the early diagnosis of cholera and of

dysentery. Cholera has appeared in the last three wars in which Turkey

has been engaged, and therefore the chances of the peninsula of

Gallipoli becoming infected are great. The early diagnosis of cases of

cholera, especially when slight, is extremely difficult and often can be

settled by bacteriological examination only.

There never has been a war without dysentery, and almost surely our

troops will be infected in time, if they are not already infected. But

whereas in previous wars the treatment of dysentery was not specific,

the physician is _now_ in possession of rapid methods of treatment,

provided he can tell what kind of dysentery (bacillary or amoebic or

mixed) he is dealing with.

This differential diagnosis is a hopeless task unless controlled at

every step by microscopical and bacteriological examination.

The French are keenly aware of this fact, so much so that they have

sent, for that very purpose, three skilled bacteriologists, two of whom

are former assistants at the Pasteur Institute, to the Gallipoli

Peninsula" (Report ends).

OTHER INFECTIOUS DISEASES

The Infectious Diseases Hospitals were filled mostly with cases of

measles and its complications, including severe otitis media. Cases of

erysipelas, scarlatina, scabies, and diphtheria were met with in small

numbers. In the autumn there was a severe epidemic of mumps.

Through the summer and autumn many cases of diarrhoea and of both

amoebic and bacillary dysentery made their appearance. There is good

ground for believing that many so-called diarrhoeal cases were

dysenteric.

There is little doubt short of absolute scientific proof that the

greater part of the intestinal diseases are fly borne.

The following table shows the admissions into the hospital, the deaths,

and causes of death, to July 31, 1915.

A subsequent table shows the deaths and causes of death in No. 2

Australian General Hospital from May 3 to August 18.

ADMISSIONS AND DEATHS INTO NO. 1 AUSTRALIAN GENERAL HOSPITAL

_From February to July inclusive_

---------+-----------+-------------+-----------------------------------

|Admissions.| Deaths. | Cause of Death.

---------+-----------+-------------+-----------------------------------

February | 1,360 | 1 | Malignant purpura

March | 1,791 | 12 | 6 Pneumonic group

| | | 3 Measles, etc.

| | | 1 Meningitis

| | | 1 Abscess, liver

| | | 1 Tumour, brain

April | 1,343 | 12 | 2 Pneumonic group

| | | 7 Measles, etc.

| | | 1 Meningitis

| | | 1 Septicæmia

| | | 1 Injury

May | 2,650 | 35 | 27 Wounds (1 tetanus)

| | | 1 Meningitis

| | | 1 Poliomyelitis

| | | 1 Cardiac

| | | 1 Pancreatitis

| | | 1 Appendicitis

| | | 3 Pneumonic group

June | 2,862 | 20 | 11 Wounds

| | | 1 Perinepritis

| | | 1 Nephritis, chronic

| | | 1 Septicæmia

| | | 1 Broncho-pneumonia endocarditis

| | | 1 Pneumonia

| | | 1 Meningitis

| | | 2 Enteric

| | | 1 Dysentery

July | 2,099 | 19 | 6 Wounds

| | | 1 Fracture, tibia

| | | 1 Enteric

| | | 6 Dysentery

| | | 1 Diphtheria

| | | 3 Meningitis

| | | 1 Enteritis

---------+-----------+-------------+-----------------------------------

In May and June 5,512 men were admitted, of whom 1,219 were Australians

and New Zealanders in camp, 2,967 Australians and New Zealanders from

the Mediterranean Expeditionary Force, 1,050 British, and 276 Naval

Division from the same force.

AUSTRALIAN IMPERIAL FORCE

_Return showing Number of Deaths at No. 2 Australian General

Hospital, Ghezireh_

_From May 3, 1915, to August 18, 1915_

AUSTRALIAN M.E.F.

Sickness 2

Wounds in Action 9

BRITISH M.E.F.

Sickness nil

Wounds in Action 1

R.N.D. M.E.F.

Sickness 1

Wounds in Action nil

NEW ZEALAND M.E.F.

Sickness 1

Wounds in Action nil

AUSTRALIAN FORCE IN EGYPT

Sickness 1

D. MACKENZIE, _Captain_.

_Secretary and Registrar, No. 2

General Hospital._

GHEZIREH,

_August 18, 1915_.

This chapter would be incomplete unless proper acknowledgment were made

of the most valuable post mortem demonstrations given by Major Watson.

CHAPTER VIII

VENEREAL DISEASES--THE GREATEST PROBLEM OF CAMP LIFE IN

EGYPT--CONDITIONS IN CAIRO--METHODS TAKEN TO LIMIT

INFECTION--MILITARY AND MEDICAL PRECAUTIONS--SOLDIERS' CLUBS.

CHAPTER VIII

The venereal-disease problem has given a great deal of trouble in Egypt

as elsewhere. The problem in Egypt does not differ materially from the

problem anywhere else, but a number of fine soldiers have been disabled

more or less permanently.

When the First Australian Division landed in Egypt and camped at Mena,

the novelty of the surroundings and the lack of intuitive discipline

resulted in somewhat of an outbreak, both with regard to conduct and to

sexual matters. Both of these phases have been greatly exaggerated, but

nevertheless there was substantial ground for apprehension, and the

following letter from General Birdwood, Commander-in-Chief of the

Australian Army Corps, to the officers commanding units was sufficient

evidence of the necessity for action.

"_For Private Circulation only_

"DIVISIONAL HEADQUARTERS, MENA,

"_December 18, 1914_.

"The following letter written by Major-General W. R. Birdwood, C.B.,

C.S.I., C.I.E., D.S.O., Commanding the Australian and New Zealand Army

Corps, to Major-General W. T. Bridges, C.M.G., Commanding the First

Australian Division, has been printed for private circulation.

"V. C. M. SELLHEIM,

"_Colonel, A.A. and Q.M.G._"

"HEADQUARTERS: AUSTRALIAN AND NEW ZEALAND ARMY CORPS,

"SHEPHEARD'S HOTEL, CAIRO,

"_December 27_, 1914.

"MY DEAR GENERAL,

"You will, I know, not misunderstand me if I write to you about the

behaviour of a very small proportion of our contingents in Cairo, as I

know well that not only you, but all your officers and non-commissioned

officers and nearly all the men must be of one mind in wishing only for

the good name of our contingents.

"Sir John Maxwell had to write recently complaining of the drunkenness

of some of our men in the Cairo streets. During Christmas time some

small licence might perhaps have been anticipated, but that time is now

over, and I still hear of many cases of drunkenness, and this the men

must stop.

"I advisedly say 'the men must stop,' because I feel it is up to the men

themselves to put a stop to it by their own good feeling. I wonder if

they fully realise that only a few days' sailing from us our

fellow-countrymen are fighting for their lives, and fighting as we have

never had to do before, simply because they know the very existence of

their country is at stake as the result of their efforts.

"We have been given some breathing time here by Lord Kitchener for one

object, and one object only--to do our best to fit ourselves to join in

the struggle to the best advantage of our country. I honestly do not

think that _all_ of our men realise that this is the case. Cairo is full

of temptations, and a few of the men seem to think they have come here

for a huge picnic; they have money and wish to get rid of it. The worst

of it is that Cairo is full of some, probably, of the most unscrupulous

people in the world, who are only too anxious to do all they can to

entice our boys into the worst of places, and possibly drug them there,

only to turn them out again in a short time to bring disgrace on the

rest of us.

"Surely the good feeling of the men as a whole must be sufficient to

stop this when they realise it. The breathing time we have left us is

but a short one and we want every single minute of it to try and make

ourselves efficient. We have to remember too that our Governments of the

Commonwealth and Dominion have sent us here at a great sacrifice to

themselves, and they fully rely on us upholding their good name, and

indeed doing much more than that, for I know they look to us to prove

that these two contingents contain the finest troops in the British

Empire (whose deeds are going down in history), whom they look forward

to welcome with all honours when we have done our share, and I hope even

more than our share, in ensuring victory over a people who would take

all we hold dear from us if we do not crush them now.

"But there is no possibility whatever of our doing ourselves full

justice unless we are every one of us absolutely physically fit, and

this no man can possibly be if he allows his body to become sodden with

drink or rotten from women, and unless he is doing his best to keep

himself efficient he is swindling the Government which has sent him to

represent it and fight for it. From perhaps a selfish point of view,

too, but in the interests of our children and children's children, it is

as necessary to keep a 'clean Australia' as a 'White Australia.'

"A very few men can take away our good name. Will you appeal to all to

realise what is before us, and from now onwards to keep before them one

thought and only one thought until this war is finished with

honour--that is, a fixed determination to think of nothing and to work

for nothing but their individual efficiency to meet the enemy.

"If the men themselves will let any who do not stick to this know what

curs they think them in shirking the work for which it has been their

privilege to be selected, then, I know well, any backslidings will stop

at once--not from thoughts of punishments, but from good feeling, which

is what we want.

"I have just been writing to Lord Kitchener telling him how intensely

proud and well-nigh overwhelmed I feel at finding myself in command of

such a magnificent body of men as we have here; no man could feel

otherwise. He will, I know, follow every movement of ours with unfailing

interest, and surely we will never risk disappointing him by allowing a

few of our men to give us a bad name. This applies equally to every one

of us, from General down to the last-joined Drummer.

"Will you and your men see to it?

"Yours very sincerely,

"W. R. BIRDWOOD."

Those who possessed any experience of life could not but realise that

18,000 particularly vigorous fine men, brought up in a country where

discipline is conspicuous by its absence, and landed for the first time

in a semi-eastern city such as Cairo, were likely to behave in such a

manner that a small minority would get into trouble. Active steps were

taken to meet the difficulties, and to prevent recurrence of the

outbreaks when the Second Division and other reinforcements arrived.

General Birdwood accordingly issued the following circular:

"WARNING TO SOLDIERS RESPECTING VENEREAL DISEASE

"Venereal diseases are very prevalent in Egypt. They are already

responsible for a material lessening of the efficiency of the

Australasian Imperial Forces, since those who are severely infected are

no longer fit to serve. A considerable number of soldiers so infected

are now being returned to Australia invalided, and in disgrace. One

death from syphilis has already occurred.

"Intercourse with public women is almost certain to be followed by

disaster. The soldier is therefore asked to consider the matter from

several points of view. In the first place if he is infected he will not

be efficient and he may be discharged. But the evil does not cease even

with the termination of his military career, for he is liable to infect

his future wife and children.

"Soldiers are also urged to abstain from the consumption of any native

alcoholic beverage offered to them for sale.

"These beverages are nearly always adulterated, and it is said that the

mixture offered for sale is often composed of pure alcohol and other

ingredients, including urine, and certainly produces serious

consequences to those who consume it. As these drinks are drugged, a

very small amount is sufficient to make a man absolutely irresponsible

for his actions.

"The General Commanding the Australasian Forces, therefore, asks each

soldier to realise that on him rests the reputation of the Australasian

Force, and he is urged at all costs and hazards to avoid the risk of

contracting venereal disease or disgracing himself by drink."

* * * * *

This leaflet was entrusted to Lieut.-Col. Barrett to deliver to troops

on arrival, and he accordingly visited Port Said and Suez, interviewed

the officers on the transports, and fully explained the position to

them. They were requested to use their influence with the men in the

direction of restraint. Subsequently after the destruction of the

_Konigsberg_ the transports began to arrive at irregular intervals and

it became impossible to meet the officers at the ports. They were then

interviewed at Abbassia or Heliopolis, and later still by order of

General Spens, G.O.C. Training Depot, the men themselves were

addressed on the day of their arrival. The form of address was simple.

The dangers of infection were pointed out to them--particularly as

regards typhoid fever, dysentery, bilharzia, and venereal disease. They

were shown how the first three diseases could be avoided. So far as

venereal disease was concerned they were informed that the matter was in

their own hands. They were asked to imitate the Japanese, and by their

own efforts preserve their health with the same care that they bestowed

on their rifles or their ammunition, the preservation of health and arms

being equally important. Passages from the famous rescript of the

Emperor of Japan before the Russian war were quoted in which it was

stated in substance that if the normal proportion of sick existed in the

Japanese army defeat was a practical certainty; but that if they

followed the direction of their medical officers and took the same care

of their bodies as they took of their equipment, the number of troops

saved thereby would make all the difference in the ensuing conflict.

[Illustration: VENEREAL DISEASES HOSPITAL, ABBASSIA.

_To face page 120_]]

General Birdwood asked for the whole-hearted and enthusiastic

co-operation of all officers in doing their best to control their men,

and to prevent them from exposing themselves to the risk of venereal

disease. Some little time before the issue of the circular 3 per cent.

of the Force were affected by venereal disease on any one day.

Fortunately, as a result of the efforts made, the tendency was to

diminution, but the amount of venereal disease was still sufficiently

great to give concern and anxiety.

There is no doubt that the action of General Birdwood prevented

outbreaks and limited the amount of disease. It is also equally true

that in spite of his efforts the amount of disease was too large to be

contemplated with equanimity.

The Venereal Diseases Hospital, Abbassia, was nearly always full, but

from time to time drafts of men were sent back to Australia. One draft

of 450 soldiers was sent to Malta early in the campaign. The principle

involved in the policy of returning them to Australia was as follows. In

Egypt they were useless as soldiers, whether suffering from gonorrhoea

or syphilis. They required a large number of medical men and attendants

to take care of them. They knew they had disgraced themselves and were a

source of trouble to every one concerned. On shipboard they could not

get into trouble. They were more likely to be cured, and could then be

returned to Egypt, and if not cured could be treated in Australia at

leisure. Against this policy the argument was used that diseases were

being introduced into Australia, but as a matter of fact a minority of

the men suffering from venereal disease brought it from Australia to

Egypt. They arrived at Suez suffering from gonorrhoea contracted in some

cases at Fremantle. Furthermore the business of those conducting the

campaign was to wage a successful war, and to keep the base as free from

encumbrance as possible. The total number returned to Australia in this

way was as follows:

From February to September 14, 1,344, and in addition 450 were sent to

Malta.

At first they were sent in ships with other cases and sometimes

segregated on board, but difficulties arose at the Australian ports. The

people who welcomed the returned soldiers were sometimes enthusiastic in

greeting venereal cases by mistake, and sometimes non-venereal cases

were regarded with suspicion because they came from a ship known to

convey venereal patients. It was finally decided by the Australian

Government that venereal cases should be conveyed in ships by

themselves, the first consignment of 369 being sent in the _Port

Lincoln_.

A certain number of the gonorrhoeal cases recovered and became fit for

service, but too often they relapsed.

The authorities were fully alive to the damage which was being done, and

persistent and earnest attempts were made to deal with it from many

different points of view. General Maxwell issued an order prohibiting

the sale of drink after an early hour (10 p.m.) in the evening, and also

prohibiting soldiers from being found in Cairo after an early hour.

There is no doubt that both of these directions proved to be of

considerable value.

MORAL CONDITIONS IN CAIRO

Something must be said, however, about the moral conditions in Cairo,

about which exaggerated and perverse notions seem to be entertained.

Cairo, like all large cities in the world, possesses its quota of

prostitutes, who differ only from prostitutes elsewhere in that the

quarters are dirtier and that the women are practically of all

nationalities, except English. The quarter in which they live is

evil-smelling, and is provided with narrow streets and objectionable

places of entertainment. It contains a considerable infusion of Eastern

musicians and the like, and is plentifully supplied with pimps of the

worst class. These men were promptly dealt with by the police, the

authorities giving the most sympathetic assistance to the military.

As in other countries, there were graduations in the class of women

employed, and the personal impression gained by the authorities was that

the danger of infection was greatest from those at the top and the

bottom of the social scale. Prostitutes who were registered were

examined by a New Zealand gynecologist, who did the work very

thoroughly, and conscientiously, and with kindness. Women who were free

from disease were furnished with a ticket indicating that they were

healthy. At the beginning of the war there were 800 of these women in

Cairo, but as the war progressed the number grew to 1,600. The

arrangement then differed in no way from the arrangements in Melbourne

or Sydney except that the surveillance of the police was direct, and

medical examination was insisted upon. It further had this advantage

over those of Melbourne and Sydney, that the women were confined to one

particular part of the city, and no one need come in contact with them

unless they wanted to. Consequently for those who went to this quarter

there is no excuse, since they acted deliberately.

PROPHYLAXIS

At the same time, when all these measures were weighed in the

balance--plain speaking to the men on arrival, police surveillance,

medical examination, etc.--it was felt that more might be done. A number

of medical officers accordingly gave instruction to their men in the

means of effecting prophylaxis and of preventing infection in the event

of association with these women. The medical officers acted entirely on

their own responsibility. They advised the men to avoid the risk, but as

they knew a certain number would not take their advice in any

circumstances--in fact the men said as much--they showed them how to

avoid infection if they would take the necessary trouble.

RESULT OF PROPHYLAXIS

In the case of our own unit, the First Australian General Hospital,

trouble was taken to explain in detail the consequences of venereal

diseases to the men, and to those with whom they would be associated in

later life. They were asked to refrain from taking the risk, but for

those who would not take the advice--and there was bound to be a

percentage--the necessary directions and material were provided for

preventing infection. The result was challenged by a medical officer,

and an immediate examination of all the men made, when it was found that

in the whole of the unit only one man was infected. In other words, the

precautions taken had practically stamped the disease out of the unit,

and shortly after arrival in Cairo.

Once the disease was acquired the treatment was troublesome to a degree.

The men knew they were disgraced; they would probably be sent back to

Australia; and in some cases, those of the finer men, the consequences

were serious. Mostly, however, they developed an attitude of sullenness

and indifference, a tendency to lack of discipline, and they rendered

the management of camps difficult. These troubles to a large extent

disappeared when a suitable hospital was established.

SOLDIERS' CLUBS

But another and constructive side of the matter appealed forcibly to

those concerned. Why not supply for the benefit of the men places of

entertainment with music, refreshments, and the like, similar to and

better than those which the prostitutes supplied, but minus the

prostitute. In other words, why not give a healthy and reasonable

alternative? After consultation with His Excellency Sir Henry MacMahon,

with the G.O.C.-in-Chief, General Sir John Maxwell, and with the D.M.S.

Egypt, General Ford, the Australian Red Cross Society determined to

combine with the Y.M.C.A. and establish clubs for the soldiers in

central positions where these requirements would be met. They

accordingly established a club at the quay in Alexandria, and a

magnificent open-air club in the Esbekieh Gardens, Cairo. They were both

immediately successful, and have played a most important part in the

further limitation of the amount of venereal disease. It is difficult to

give statistical evidence, but there is no doubt that by these various

means a sensible difference has been produced in the incidence of

disease amongst the troops.

THE DUTY OF THE MEDICAL OFFICER

We have never wavered from the conviction that any one suffering from

venereal disease should be treated by a medical practitioner exactly

like any other sick person. In military service, however, an added

element makes its appearance in that the soldier by his act has rendered

himself unfit, and consequently must suffer some pains and penalties. It

is no answer to say that other men have exposed themselves and have not

become infected. The fact remains that he has by a deliberate and

avoidable act deprived his country of the value of his services. And

whilst the doctrine of punishment should not be pushed too far, he

certainly should not receive the same general treatment as other

soldiers, and the policy of his prompt return to Australia and

deprivation of pay was in the circumstances the best one.

In the Venereal Diseases Hospital, Abbassia, the men were well treated.

They were well fed, and a certain amount of Red Cross help was given to

them.

Many proposals were made which were not carried into effect: for

example, placing of the prostitute quarter "out of bounds" and the

posting of sentries. It was realised that the immediate effect of this

action would have been to drive women to the vicinity of the camps, and

that it was impracticable. Another practicable proposal was made, which,

however, was not carried into effect--the creation of dispensaries in

the vicinity of the prostitute quarter, so that immediate treatment

could be obtained. In many camps such dispensaries were established by

the medical officers.

The essence of the problem was learnt by a Brigadier-General who visited

a number of young educated men in one of the camps, and asked them for

their viewpoint on the subject. Their answer was that which every

medical officer knows full well: that many men were influenced by the

appeals which had been made to them, but that a percentage have indulged

in this way throughout their adult life, and intend to continue to do so

irrespective of anything medical officers, chaplains, or generals may

say to them. It is this fundamental position which every reformer must

face. So long as a sufficient number of men determine to adopt this

policy, and so long as there is a sufficient number of women prepared to

cater for them, the problem of venereal disease will continue to be

acute in every country.

The opinion has been expressed elsewhere that the world will not be

rendered more or less moral by the abolition of venereal disease, and

instruction in the mode of preventing infection should be an essential

part of education. Because people are immoral there is no reason why

they should acquire gonorrhoea or syphilis. If the _lex talionis_ is to

be enforced, the logical way to deal with the matter is to refuse

treatment to all the infected, and to let them die or become disabled.

But the most thorough-going Puritan shrinks from adopting so terrible a

policy. One method or the other, however, must be adopted--there can be

no half-way house. And if the decision be in favour of eradicating the

disease, it is essential to firmly face and grapple with the problem.

WASSERMANN TESTS

The examination of the cases showed that gonorrhoea was far more common

than syphilis, and a series of Wassermann determinations showed that the

cases of soft sores did not give a syphilitic reaction in the early

stages. Captain Watson of the First General Hospital made a number of

determinations in order to try to settle this important point.

THE POLICY TO BE ADOPTED

In spite of all that was done, 1,344 men were returned to Australia

disabled, and 450 were sent to Malta. If a calculation be made of the

cost of sending these men to Egypt and back, and of their pay before

they were infected, some idea may be formed of the enormous sum of money

the Australian Commonwealth wasted on men who were a drag and hindrance

to the army machine.

The Government should, on the raising and equipping of a volunteer

army, treat it as older countries treat a standing army by issuing

instructions to the men.

When the Hospitals left Australia neither officers nor men received

instructions, and not until the arrival of Surgeon-General Williams in

Egypt was any serious collective action taken. He at once called a

conference of medical officers and did what he could to limit the extent

of disease.

The governmental action--or lack of action--is unsound, since the man

who contracts disease is severely punished, but adequate attempts are

not made to prevent him acquiring it. The notable departure made in the

case of Cairo was the effort to make the men understand clearly what

these diseases meant to them as soldiers and as citizens; to remove

temptation from them as far as possible, and with the aid of the

Australian Red Cross to give them a reasonable, healthy, and decent

alternative. Nothing the Australian Red Cross has done (or is likely to

do) is more important than the establishment of the Soldiers' Clubs.

Nothing has been more successful or is likely so to redound to the

credit of that great institution. And yet, under the new Constitution of

the Australian Red Cross, not a shilling can be devoted in the future to

such purposes.

VENEREAL DISEASES CONFERENCE

The following are brief notes of a Conference of senior medical officers

convened by Surgeon-General Williams.

Reference was made to the gravity of the problem with which the force

was faced. It was estimated that about 1,000 men of the First and Second

Australian Divisions are suffering from venereal disease on any one day,

and of these a large number are incapacitated from work. The proportions

seemed to be much greater than those of other forces, such as the

Territorials, in Egypt. The displacement of so large a proportion of men

and the ultimate consequence of numerous infections, rendered it

necessary to take a comprehensive view of the position, and to endeavour

to take some action to minimise the damage done. It was proposed to ask

each officer present to furnish the secretary with a general statement

of the number of cases treated under their command, specifying them

under three headings--syphilis, soft chancre, and gonorrhoea. The

information so obtained would form the basis of a report to

headquarters. The problem was considered under five headings:

1. Military assistance.

2. Use of prophylaxis.

3. Treatment--general and special.

4. Establishment of convalescent depots--accommodation and position.

5. Ultimate destination of affected men.

1. _In what way can the military authorities give assistance?_--There

are three ways in which they can approach the problem:

(_a_) They may decide that all areas known to contain brothels

are out of bounds.

(_b_) They can provide adequate military control by military

police organised under a competent officer, with one or more

junior medical officers to assist him.

(_c_) That punishment can be inflicted on those men who break

bounds and expose themselves to the risk of venereal infection.

It might be desirable to reduce the pay of men found in those

areas whether suffering from venereal disease or not.

2. _Prophylaxis._--Officers were invited to discuss the question whether

it would not be advisable to establish prophylactic depots in various

parts of Cairo. Men to report immediately after exposing themselves to

infection, and by cleanliness and the use of medicaments prevent

infection. Circulars couched in plain and sensible language might be

issued to the troops, conveying to them a knowledge of the risk they

run, and the fact that if infected they will take back to Australia a

disease which would reduce their value as citizens.

3. _General and Special Treatment._--Suggestions from officers present

were invited.

4. _Convalescent Depots._--Was it right that the hospital should be

crowded out with venereal cases, which demanded very much time and

attention from the staffs? If the hospital was placed near the scene of

military action the wounded might suffer from the amount of attention

required for venereal cases. Most venereal cases required rest in the

main, and this could be obtained in convalescent depots.

5. _The ultimate destination of the affected men._--Two courses are

open: The men may be treated in Egypt, or sent back to Australia.

(_a_) If they are kept in Egypt and the Australian Expeditionary

Force is moved to the front its medical services would be

depleted, and medical men of great ability and experience would

be left behind to take charge of venereal cases when their

services were required at the front.

(_b_) If on the other hand the Australian and Imperial

Government could utilise some ships for the accommodation of

these men, those who were cured could be sent to the front, and

those who could not be cured could be sent back to Australia at

once. But such ships would require special staffing so that the

existing units should not be depleted in order to provide

staffs.

In the discussion which ensued it was represented that there was a

difficulty in placing areas out of bounds, as the brothels would be

moved to other areas. Prophylaxis was regarded as most important.

Isolation tents could be set apart in the regimental lines where men

could be treated on return from leave. Cases of syphilis should be sent

to Australia.

The reduction of pay is forbidden by King's Regulations, and although

the Minister for Defence in the Commonwealth of Australia authorised

such reduction, it is only for such period as the troops are in Egypt.

It was agreed that cases of syphilis should be returned to Australia, as

there is no chance in Egypt of treating them efficiently, and even if

such treatment were available the men would not be fit for duty for from

four to six months.

It was pointed out that at least 100 men left Australia with the First

Division suffering from venereal disease.

[Illustration: SOLDIERS' CLUB, ESBEKIEH, CAIRO.

_To face page 133_]]

The chief difficulty seemed to be what venereal cases would ultimately

be of service to a fighting line, and to properly arrange for them

during convalescence; in other words, when and how men considered unfit

for further service should be returned to Australia. Officers were asked

to recollect that the future of these soldiers was to be considered and

the part they would play in civil life. In the American Navy unbounded

shore leave had been given, and had some effect in checking the disease.

In the British Navy it was an offence not to report "exposure."

* * * * *

The Soldiers' Clubs are fully described in the chapter on the Red Cross.

They were rendered possible by an alliance between the Y.M.C.A. and the

Australian Branch British Red Cross. To the Y.M.C.A., who managed them,

the best thanks of Australia should be given, for Australians will never

fully know what they owe to Mr. Jessop and his assistants.

Unfortunately, the Australian Branch British Red Cross subsequently

decided that help should be given _only_ to sick and wounded. Although

convalescents frequent these clubs, the view was taken--we think

wrongly--that Red Cross funds could not be used for their support. We

feel sure that when Australians fully understand the matter the decision

will be reversed.

CHAPTER IX

THE RED CROSS WORK: ITS VALUE AND LIMITATIONS--ORIGIN IN

AUSTRALIA--REPORT OF EXECUTIVE OFFICER IN EGYPT--RED CROSS

POLICY--DEFECTS OF CIVIL AND THE ADVANTAGES OF MILITARY

ADMINISTRATION--WHAT WAS ACTUALLY DONE IN EGYPT.

CHAPTER IX

The British Red Cross Society, Australian Branch, was founded by Her

Excellency Lady Helen Munro Ferguson, wife of the Governor-General of

Australia, on the outbreak of war. On previous occasions unsuccessful

attempts had been made to found an Australian Red Cross Society. On this

occasion the movement was most successful, although many people then

(like some people now) were quite unable to understand the distinction

between the Red Cross movement and military administration.

The Red Cross Society in Australia undertook the collection of funds for

immediate transmission to the British Red Cross Society for prompt use

in the field. Branches were formed in each State and committees were

formed by the wives of the various governors. Thus a rough-and-ready

arrangement was made prior to the adoption of a constitution. It was

considered far more important to do the work than to waste time holding

meetings and devising a constitution. Those who could not afford to give

money were invited to make clothing or to contribute articles of various

kinds. Specifications of the clothing requisite were given, and patterns

furnished so that it might be readily made on approved design. It is not

too much to say that the majority of the inhabitants of the Continent

were soon engaged in some way or other in helping the Red Cross

movement. The ball-rooms of the respective Government Houses were used

as depots. The depot at Federal Government House, Melbourne, was an

excellent model. People were invited to send their donations

irrespective of their number or their kind. These were received and

receipted, and were then sorted into bundles of similar articles by lady

volunteers. They were then placed in cases by volunteer packers, mostly

experienced men from various warehouses, and were finally dispatched to

Europe as opportunity offered.

The arrangement of these details fell largely on the Council and

Secretary of the Branch (one of us, J. W. B.) in Australia acting under

the direction of the President, Her Excellency Lady Helen Munro

Ferguson. Very great difficulty was experienced in finding space in

merchant ships for the conveyance of the goods. Space was found on the

transports, but there was not the same security for delivery. In

addition the hospitals of the transports were provided with such

equipment as the officers commanding desired.

When, however, the Lines of Communication Units were ordered to Egypt,

another problem arose, and the Australian Red Cross Society decided to

properly equip these units both with money and goods. For this purpose

£10,000 was set aside and forwarded to London. It was handed to the

British Red Cross Society and kept available for the officers commanding

the five hospitals, the requisite sum of money to be allotted to them by

Surgeon-General Williams, C.B., the Director of Medical Services in

Australia, who had proceeded to Europe. At the time it was supposed that

these five hospitals were proceeding to France. In addition large

quantities of goods were available at the British Red Cross Society in

London, and large quantities of goods were given to the several

hospitals for dispatch with their equipment. When, however, the

hospitals were sent to Egypt a new situation arose. There were many

other medical units in Egypt besides the hospitals. There were the Field

Ambulances and the Regimental Medical Officers, and Surgeon-General

Williams regarded them as equally worthy of assistance. On his arrival

in Egypt at first, in December, and subsequently in the middle of

February, the scope of the British Red Cross, Australian Branch, in

relation to Australian troops had extended far beyond the original

intention. The action taken is described in the following report sent to

the President and members of the Council, British Red Cross Society,

Australian Branch, on my resignation (Lieut.-Col. Barrett) from that

body on September 9, 1915. I did not at any time receive any

instructions from Australia, and acted in the manner which seemed best

after consultation with local authorities.

REPORT ON THE WORK OF THE AUSTRALIAN BRANCH BRITISH RED CROSS IN

EGYPT, FROM MARCH TO SEPTEMBER 3, 1915

_By_ JAMES W. BARRETT, _Lieut.-Colonel, Lately Executive

Officer, Australian Branch British Red Cross Society_

REPORT PRESENTED TO THE PRESIDENT AND MEMBERS OF THE COUNCIL OF

THE AUSTRALIAN BRANCH BRITISH RED CROSS SOCIETY

The First Australian General Hospital arrived in Egypt in January 1915.

I was associated with it as Registrar and Oculist and had nothing to do

with the Red Cross movement beyond assuming responsibility for any Red

Cross goods which belonged to the Hospital.

When leaving Melbourne Colonel Ramsay Smith was informed that there

would be room for 100 tons of Red Cross goods in the _Kyarra_. When,

however, the _Kyarra_ reached Melbourne her holds were full and no Red

Cross goods were taken on board. There were consequently not any Red

Cross goods available at No. 1 Australian General Hospital for some

considerable time after arrival in Egypt.

Surgeon-General Williams, C.B., arrived in Egypt in the middle of

February, and at once proceeded to organise the Red Cross movement. He

had been entrusted with £10,000 which was to be expended by the officers

commanding medical units according to the plan set out later. He at once

took action, and money was distributed to a number of hospitals and

medical units. This distribution was of the utmost service.

[Illustration: HELIOPOLIS PALACE HOTEL.

_To face page 141_]]

When Red Cross goods began to arrive in Egypt he sought a suitable

store. Finding nothing in Cairo at a reasonable price, he established a

store in the basement of the Heliopolis Palace Hotel, No. 1 Australian

General Hospital, for which, of course, no rental was charged. The store

was placed under the immediate charge of the Orderly Medical Officer,

Captain Max Yuille, and under my general direction. The distribution of

money and collection of goods from ships was effected by General

Williams through his own office in Cairo.

General Williams left for London on duty on April 25, leaving me in

charge of the Red Cross work, and leaving his Warrant Officer, Mr.

Drummond, in his office to continue the collection of goods and the

clerical work.

Soon after he had left, the crisis of May and June took place. Wounded

and sick were poured into Cairo on a scale probably never known or

equalled before. There have been occasions on which a much larger number

of men have been wounded, but probably never any occasion in history in

which so many wounded men have been handled in so limited a space.

Fortunately preparation had been made by the D.M.S. Egypt,

Surgeon-General Ford, D.S.O., and the D.M.S. A.I.F., Surgeon-General

Williams, C.B., who instructed the O.C. First Australian General

Hospital, Colonel Ramsay Smith, and myself as registrar to take over

extra buildings and provide equipment. It was this action which

prevented a disaster, and whilst not strictly a Red Cross matter was

greatly aided by Red Cross equipment.

During this crisis I was instructed by the D.M.S. Egypt, Surgeon-General

Ford, and the O.C. Australian Intermediate Base, Colonel Sellheim, to

visit various hospitals in Egypt--both in Alexandria and the

provinces--to interview the Australian wounded and supply all reasonable

comforts. In accordance with this order, money and goods, either or

both, were sent to various hospitals as set out in the various tables.

It so happened that the British Red Cross Society possessed neither

money nor goods at the inception of the crisis, and the authorities were

profoundly grateful for the help which the Australian Branch afforded.

The British Red Cross, Egyptian Branch, at a later stage received large

supplies of money and goods which were freely distributed. The fact that

goods could be obtained from the British Red Cross Society, Australian

Branch, soon became known, and many requisitions were received. The list

of goods available was widely circulated and in no instance was the

requisition of any Officer Commanding not complied with. It was always

completed to the extent of our resources. Periodical reports of the work

done were prepared and forwarded to the President of the Australian

Branch British Red Cross Society, Melbourne.

Whilst the work was at its height a message from Australia reached His

Excellency Sir Henry MacMahon, in consequence of which two Committees

were formed on June 3, 1915--a General Egyptian Committee and an

Executive Committee.

The members were:

{ President, His Excellency Sir Henry MacMahon.

General { Lord Edward Cecil.

Committee { Sir Alexander Baird.

{ Sir Courtauld Thomson.

{ Sir John Rogers.

Executive { Dr. Ruffer.

Committee { Surgeon-General Williams.

{ Lieut.-Colonel Barrett.

Sir Courtauld Thomson is the Commissioner in the Mediterranean for the

British Red Cross Society, and Sir John Rogers and Dr. Ruffer Deputy

Commissioners in Egypt.

Surgeon-General Williams and Lieut.-Col. Barrett were appointed members

of the Executive Committee of the British Red Cross Society in Egypt.

There was no amalgamation of the two branches, but by this arrangement

each was kept informed of the activity of the other and wasteful

overlapping was avoided.

Members of the General Committee investigated the work of the Australian

Branch, were consulted in matters of policy, and received and

investigated any complaints. They were most helpful.

General Williams returned to Egypt on June 21, made a tour of

inspection, and visited the Australian wounded. He reported to the

Government, and finally left for London on duty on June 29. On this

occasion he took with him his office staff, and consequently the

administration fell largely into my hands.

On July 13, however, I learned by cable from Australia that two

Commissioners had been appointed in terms which seemed to place them in

entire control of the Red Cross movement.

As it was desirable that other medical officers should be associated

with the movement. Colonel Ryan, Colonel Martin, and Lieut.-Col.

Springthorpe were invited by His Excellency Sir Henry MacMahon to join

the Executive Committee.

Mr. Adrian Knox, K. C., the first of the Commissioners, arrived in Cairo

on August 11, and the second Commissioner, Mr. Brookes, reported on

August 27. I endeavoured to help them in every way that was possible,

and finally asked to be relieved of the work on September 9, expressing

my willingness, however, to continue to aid in any way they desired. My

relationship to them has been cordial, and I am very glad if I have been

able to be of any assistance.

I now propose to deal with the operations of the Society under various

headings:

1. _Finance._--The original fund in the hands of Surgeon-General

Williams was operated upon by him in London, in Malta, and in Egypt. It

was only in Egypt that I was concerned with it, and to a limited extent.

It was most helpful, and great service was rendered during the crisis by

the prompt distribution of money.

When the General Committee, of which His Excellency Sir Henry MacMahon

is President, was formed, separate funds were forwarded to him in

response to a cable from me indicating that more money was wanted. I

suggested the supply of another £10,000, but when, on July 9, £18,000

had been received it became obvious that operations were contemplated on

a more extensive scale than had hitherto been thought necessary. I have

prepared a summary of the amounts distributed to medical units from both

funds, and given an account of the method adopted.

The Red Cross Society originally intended that £10,000 was to be

expended by the officers commanding medical units, and General Williams

embodied the direction in the following circular, to which I

subsequently added a memorandum in further explanation of new conditions

which had arisen.

[Illustration: INTERIOR OF RED CROSS STORE: UTILISATION OF CASES FOR

SHELVING.

_To face page_ 144]]

_Australian Imperial Force_

Received from Surgeon-General W. D. C. Williams, Director Medical

Service, A.I.F., the sum of ---------------- stg. to be utilised and

accounted for by me in terms of Circular Letter No. E 1/15, dated

13-2-15.

---------------- O.C.

_Place_ ----------------

_Date_ ----------------

_Australian Imperial Force_

Circular Letter No. E 1/15.

O.C.,

1. Forwarded herewith the sum of ---------------- stg. to be expended by

your authority and direction on such articles as you may consider

requisite for the general improvement of equipment, stores, or other

items which in your opinion will conduce to the general well-being and

comfort of the patients in hospital under your command.

2. Attached receipt forms to be signed in duplicate and returned to me.

3. When three-fourths of the amount allocated to you has been expended,

you will furnish this office with expenditure vouchers in duplicate.

This will enable me to keep the High Commissioner informed as to how the

moneys are being spent, and to arrange for further grants if considered

necessary.

SURGEON-GENERAL,

_Director Medical Services, A.I.F._

[_Copy_]

_May 20, 1915._

O.C.

Govt. Hospt.

Tanta, Damanhour and Shebin el Kom.

1. I enclose herewith cheque for {£50 £25 £25} to be expended in terms

of the Circular Letter attached. Will you please sign the accompanying

receipt in duplicate and oblige.

2. It is not desired that the expenditure of the money should be

restricted to Australians, as such a course would, I think, in a

hospital be impracticable and undesirable. If, however, this is used for

all the Allied troops under your care, then the next instalment which

may become necessary might well be provided from the "Military Hospitals

Fund" or the "Egyptian Red Cross Fund."

3. I shall be glad if you will communicate to the men in the Hospital

the fact that comforts are being supplied from the Fund of the British

Red Cross Society (Australian Branch), the administration of which fund

is in the hands of Surgeon-General W. D. C. Williams, C.B.

(_Signed_)

JAMES W. BARRETT,

_Major_,

for W. D. C. WILLIAMS,

_Surgeon-General_.

GRANTS OF MONEY MADE TO VARIOUS HOSPITALS FROM RED CROSS FUNDS

Hospital or Medical Unit, etc. Amount in

Egyptian

pounds.

First Australian General Hospital and

Auxiliaries 1376,42.5

Second Australian General Hospital 682,50

Share of Rent of Luna Park for three

months 117,00

Y.M.C.A. (including stationery, building

fund, Soldiers' Café, and sundry accounts) 982,08.6

Venereal Hospital, Abbassia 48,75

Deaconess Hospital, Alexandria 78,00

European Hospital, Alexandria 48,75

Government Hospital, Tanta 53,62.5

No. 21 General Hospital, Alexandria 97,50

Convalescent Home, Al Hayat, Helouan 341,25

Convalescent Home, Ras el Tin, Alexandria 97,50

A.D.M.S., First Australian Division 292,50

First Stationary Hospital 195,00

Second Australian Stationary Hospital 196,24.7

First Casualty Clearing Station 146,25

Fourth Field Ambulance 290,00.2

First Light Horse Field Ambulance 97,50

Second Light Horse Field Ambulance 195,00

Third Light Horse Field Ambulance 48,75

Fifth General Hospital 97,50

Fifteenth Stationary Hospital 97,50

17th General Hospital 146,25

Bombay Presidency Hospital 58,50

Government Hospital, Alexandria 48,75

Convalescent Camp, Mustapha 48,75

Government Hospital, Damanhour 24,37.5

Government Hospital, Shebin el Kom 34,12.5

5th Indian General Hospital, Alexandria 48,75

Government Hospital, Benha 5,00

Greek Hospital, Alexandria 29,25

Government Hospital, Suez 24,37.5

Red Cross Depot, Suez 48,75

Ras el Tin Hospital, Alexandria 195,00

15th General Hospital, Alexandria 48,75

----------

£E.6340,26

The Egyptian pound is to the British pound sterling as 100:97·5.

In addition, a considerable amount of money had been spent in other

countries. There was, however, no knowledge in Egypt of the sum which

would be ultimately available. Furthermore, in the absence of

instructions from Australia, no serious departure had been made from the

policy originally laid down. In fact I am doubtful to a degree whether

any Red Cross movement should in normal conditions go beyond the

successful policy adopted.

2. _Red Cross Store._--Goods received were passed into the Red Cross

store, the contents of the cases ascertained as far as possible, and

entered in books kept for that purpose. They were issued on requisition

signed by the Officer Commanding any medical unit. Corresponding entry

was made in the book of issue, and the difference between the stock

received and that issued from day to day was shown in the form of a

stock sheet. Stock-taking was effected from time to time.

[Illustration: RED CROSS BASE DEPOT, HELIOPOLIS.

_To face page 148_]]

The store was staffed at first by two nurses and three orderlies, later

it was staffed by a sergeant and six or seven orderlies who were

approved by the military authorities. The staff therefore consisted of

myself, with my own clerical staff, the orderly officer of the hospital,

Captain Max Yuille (latterly Captain Dunn), the sergeant and seven

orderlies, together with extra helpers at times. The store was connected

by telephone with the hospital, and every effort made, compatible with

the excessive demands on the time of all, to manage it in a methodical

manner.

3. _Receipt of Goods._--The receipt of goods has, owing to the

peculiarities of Egypt and the circumstances of the war, given a good

deal of trouble, and I am making it the subject of a separate

memorandum. It may suffice here to say that it will never be

satisfactory until the Red Cross Society in Australia cables, when the

ship leaves Fremantle, precisely the number of packages on board, the

port of destination, and the probable time of arrival of the ship; and

also accurately informs the officers commanding the ship of the nature

of the Red Cross goods on board. In this connection it may be

interesting to note the following letter from Colonel Onslow, who has

just arrived by the _Runic_ in Egypt, and who, but for the printed

instructions drawn up by me and conveyed to him at Suez, would not have

known that any Red Cross goods were on board:

CONTINENTAL HOTEL, CAIRO,

_September 13, 1915_.

LIEUT.-COLONEL BARRETT,

A.A.M.C.

MY DEAR SIR,

You will remember that on Saturday last you asked me to write to you

regarding the Red Cross Stores on the Transport A 54 _Runic_ of which I

was in military command.

When I took command on August 9 in Sydney I had no information as to

there being any Red Cross Stores on board except that one of the ladies

of the Red Cross Committee had told me that a few stores were to be put

on board and would be at my disposal if needed for the troops under my

command.

Subsequently I saw some half a dozen cases which I assumed to be those

to which she had alluded.

On arrival at Suez, September 9, the printed instructions as to disposal

of Red Cross Stores were handed to me. This caused me to make inquiries.

The ship's purser knew nothing of any such stores and they were not

shown in the manifest.

But from the Chief Officer I learned that a large number of which he had

an incomplete list had been placed in one of the holds. It was even then

too late for me to ascertain their number or nature, as I was in the

midst of disembarking returning ship stores, etc. They were therefore

landed without the required list.

But if either a wireless had been sent to me a day or two beforehand, or

if the persons responsible for shipping had informed me in Sydney, there

would have been no difficulty whatever. Under the lack of system which

would seem to prevail in shipping these stores from Australia it would

not be surprising if they were overcarried and lost.

Yours faithfully,

(_Signed_) J. MACARTHUR ONSLOW,

_Colonel_.

I publish this letter simply to show the difficulties and to indicate

the magnitude of the task. I do not think any one is to blame, but

rectification is wanted. A huge commercial concern has gradually grown

up and now requires firm paid commercial management. The Australian Red

Cross has become a gigantic Commercial Institution with attendant

advantages and disadvantages.

It should be remembered that goods are shipped in Australia from at

least six different ports separated by distances of hundreds of miles,

that nearly the whole of the work has been amateur, and that it is

difficult to inaugurate a proper business system rapidly.

The following are the printed directions referred to by Colonel Onslow:

HEADQUARTERS, CAIRO.

_From_ A.D.M.S., Australian Force,

Headquarters, Cairo.

_To_ O.C. Troopship----

1. Will you please instruct a Medical Officer to make a list in

duplicate of the surplus medical stores and Red Cross goods, including

ambulances, on the ship. He will hand one list to the representative of

Australian Intermediate Base (Captain Clayton) and retain the other.

2. Will you please detail a Medical Officer, or if that be impossible

another Commissioned Officer, who will see that these goods are put on

the train, and travel with them to their point of destination.

3. At the place of destination he will hand them over with an inventory

to a representative of A.D.M.S. Australian Force (Lieut.-Colonel

Barrett), from whom he will obtain a receipt. He will not, under any

circumstances, hand them over to any one else, or take any verbal

receipt.

4. If it be impossible to send the goods by passenger train they may

proceed by goods train, in which case an N.C.O. or orderly must be

detailed to travel in the brake van; and deliver the goods to a

representative of A.D.M.S. Australian Force (Lieut.-Colonel Barrett) in

precisely the same way.

5. You will please detail a fatigue party of sufficient strength for

unloading the goods from the transport and placing them on the train,

and in addition supply any guard that is necessary to protect them until

this work is completed.

6. It is undesirable in any circumstances to send goods by troop train.

It is much better to send them by goods train.

7. Will you please convey these orders in writing to the Medical Officer

or Officer concerned. If any conflicting orders be issued he can then

produce this authority.

A.D.M.S. AUSTRALIAN FORCE.

4. _Distribution of Goods._--The distribution of goods was effected on

requisition signed by the O.C. of the medical unit requiring them,

transport was provided by the Red Cross Society to the railway station

(usually by motor lorries) and at public expense on the railways. I soon

learnt that in Egypt in time of war there is no certainty of the

delivery of the goods to the proper quarter unless some one is sent with

them. The railway officials will frequently hand over goods to a

military officer without obtaining a receipt. Accordingly one or more

orderlies were sent with every train conveying Red Cross goods. They

handed the goods to the consignee and brought back the receipt.

In the Australian hospitals the distribution of goods was effected by

two methods. Anything wanted from the central store could be obtained by

requisition signed by the O.C. of the hospital, and countersigned by

myself as Red Cross officer. Very large quantities of goods were thus

transferred from the central store to the quartermaster's department.

They were then issued in the ordinary way by requisition of the sisters

or medical officers, and those receiving them were not aware whether

they were receiving Red Cross goods or Ordnance goods. The system had

the merit of extreme simplicity, and was very speedy in its operation.

It certainly seemed at the time far less important that patients should

know where the goods came from than that they should obtain them

promptly. Later on the expediency of putting a Red Cross label on

everything supplied became obvious and was adopted as a policy.

5. _Scope of Operations._--At first the operations of the Society were

confined to Egypt, but soon, in conjunction with the British Red Cross,

goods were forwarded to the Dardanelles and elsewhere. The tables show

the quantity of goods sent to transports in the Mediterranean and

transports leaving for Australia. No request was ever refused. When

dispatching goods to the Dardanelles it was considered better to act,

as far as possible, through the British Red Cross Society.

On July 5 I wrote to General Birdwood, Commanding Officer A. and N.Z.

Army Corps, asking him whether I could establish a Red Cross store at

Anzac. He replied that it was impossible, but at his suggestion a Red

Cross store at Mudros in the island of Lemnos was organised in

conjunction with the British Red Cross Society. The Army Medical Corps

at Anzac was then advised to requisition on Mudros. The difficulties,

however, of landing goods at Mudros were very great--so great that the

British Red Cross Society was compelled to buy launches and lighters.

The Australian Red Cross Commissioners are about to supplement the

purchase. The tables show the quantity and character of the goods sent

forward in spite of many difficulties. It was often necessary to send an

orderly in the hospital ship to Mudros and Anzac to ensure delivery.

6. _Other Activities._--The British Red Cross Australian Branch arranged

through the Y.M.C.A. for the free distribution of stationery to the

soldiers in hospitals in Egypt. With the assistance of the Y.M.C.A. and

some English ladies in Cairo a number of committees were formed to

entertain the sick and wounded in various ways. A cinema was purchased,

a small orchestra was engaged to visit the hospitals, bands of ladies

agreed to take flowers and the like to the hospitals, and everything was

done that could be done to render the tedium of convalescence less

objectionable.

Large recreation huts were built at many of the hospitals at the expense

of the Australian Branch.

This phase of the work should not be passed over without the most

handsome acknowledgment to the English ladies in Cairo. These

public-spirited ladies, headed by Mrs. Elgood, thoroughly organised what

I may call the lighter side of hospital work, and not only by their

personal attention, but also by their tactful skill, succeeded in making

the conditions of the sick and wounded much more comfortable.

Furthermore although we left Australia knowing that the Y.M.C.A. did

good work in camps, yet the practical experience of the Y.M.C.A. work in

Egypt has left an indelible impression on our minds. Headed by Mr.

Jessop, their secretary, there was no service in connection with the

sick and wounded which they failed to render when provided with the

proper means. We felt the utmost confidence in entrusting them with any

undertaking, provided that the position was clearly defined and provided

that they were not hampered in their activities.

In passing it may be said that until June 15 the shortage of nurses and

medical officers was considerable. Of lay helpers there were few in

Cairo during the summer, and the principle was invariably adopted of

using all existing agencies to cover the ground, the necessary support

being given by the Red Cross Society. It was on this principle that Mrs.

Elgood acted, it was on this principle that the Y.M.C.A. acted, and it

is on this principle that all great organisations can be most

successfully conducted. If it had become necessary to create an

independent organisation to provide cinemas and bands, to disburse

stationery in Egypt and at the Dardanelles, distribute flowers, fruit,

games, etc., a very large number of soldiers would have been employed

who were much better employed otherwise. Furthermore, they would not

have done the work as well as Mrs. Elgood's staff or the Y.M.C.A.

7. _Issue of Purchased Goods._--As the fund grew in volume it was

decided to spend some of it in the purchase of articles desired by the

men. A vote was taken at No. 1 Auxiliary Convalescent Depot (Luna Park)

to ascertain the articles the men most desired--see appendix. Boxes

containing a number of articles were issued to every patient on

admission. This has involved an expenditure rising to £500 per month. A

sample box has already been sent to Australia. In each box the following

note was placed:

"The object of the Australian Red Cross Society is to provide comfort

and help to the wounded and sick soldiers, such as hospital clothing,

invalid comforts, tobacco, toilet necessaries, books, magazines,

newspapers, and the like, and also recreation huts for entertainment,

etc.

"These comforts are supplied over and above the hospital necessaries

which the Commonwealth of Australia furnishes on so liberal a scale.

"The Society hopes that your stay in the hospital will be short and

pleasant, and that your convalescence will be rapid so that you can

speedily serve your country again. The Society asks you to accept the

contents of this box as an indication of Australia's desire to help

you."

8. _Convalescent Home at Montazah._--The Montazah palace, which was

owned by the late Khedive, was offered to Lady Graham by H.H. the Sultan

as a Convalescent Home for soldiers. The British Red Cross Society and

the Australian Branch combined and agreed to find £3,500 to equip it.

This beautiful hospital consists of a number of buildings situated on

the shore of the Mediterranean, with artificial harbours and provision

for bathing, fishing, and boating. It is now in excellent order and is

most successful.

While I think it was right to take a share in the erection of this

convalescent home, which indeed could not have been obtained as a

military hospital, it immediately raised in mind the consideration of

the propriety of the Red Cross conducting hospitals in any

circumstances. It is of course the English practice, and the special

circumstances of Great Britain may make it necessary to erect Red Cross

hospitals. The Commonwealth of Australia has never prevented the

establishment of as many hospitals as may be considered necessary in the

field. In my judgment it is better to limit the conduct of military

hospitals and convalescent hospitals to official authority, leaving the

Red Cross to supplement the work in the way already indicated. Otherwise

the Red Cross is simply doing Governmental work. The Red Cross may do

the work very well indeed, but the advantage is not obvious.

9. _Motor Transport._--The motor ambulances presented by the Australian

Branch have been housed in two garages, one at Heliopolis and the other

at Gezira. They were both designed by Surgeon-General Williams and

provided from Red Cross Funds. It is not too much to say that the

organisation of the motor transport assisted materially in saving the

position. For a long time, with the exception of some New Zealand

ambulances, there were no other ambulances in Egypt. At Heliopolis a

repairing plant was installed at Red Cross expense in order to reduce

the cost of repairs.

There is no doubt that the British Red Cross Australian Branch was at

the outset of exceptional service because it possessed on the spot

stores, money, and motor transport.

10. _Bureau of Inquiry._--The British Red Cross Society instituted a

bureau of inquiry in order to obtain supplemental information about the

sick and wounded. Inquiries on an elaborate scale are made at the office

of the Commonwealth Government, but certain supplementary and private

inquiries can be made with profit. The British Red Cross Society was

requested to undertake such inquiries and to charge Australian Red Cross

for the extra assistance necessitated.

11. _Hospital Trains._--At an early stage steps were taken to equip

hospital trains running from Alexandria to Cairo with everything the

officers in charge required.

Furthermore, arrangements were made at Red Cross expense to provide a

restaurant car on all trains conveying sick and wounded to Suez. For

detailed arrangements see page 166. This arrangement has proved of great

benefit. The men obtained free lime juice and water and their rations.

They could purchase in addition comforts at bed-rock prices. The

innovation may seem a small one, but it was not effected without

considerable trouble owing to shortage of rolling stock.

LIST OF RED CROSS GOODS ISSUED TO UNITS FROM END OF MARCH TO

SEPTEMBER 3, 1915

_Prepared by Staff-Sergeant Hudson_

Unit. Articles. Cases. Pkgs.

First Australian General Hospital 76,350 462 39

No. 1 Auxiliary Convalescent Depot 3,377 22

No. 2 Auxiliary Convalescent Depot 11,340 78 7

No. 3 Auxiliary Convalescent Depot 6,393 74 13

Infectious Diseases Hospital, Choubra 6,303 7

Ras el Tin Convalescent Home 19,562 65 8

Al Hayat Convalescent Home 36,050 92 2

No. 2 Australian General Hospital, Ghezira 25,437 75 4

Mena Australian Hospital 2,705 4 2

Venereal Diseases Hospital, Abbassia 7,626 22 2

Hospital ships and transports 46,350 19

Imbros Rest Camp Hospital 650 70

Kasr el Aini 13,372 11

Greek Hospital, Alexandria 1,381

Colonel Bryant, Lemnos 23,236 127 8 sacks

4th Field Ambulance, Dardanelles 8,472 2

1st Stationary Hospital, Lemnos 42,333 107 12 sacks

2nd Stationary Hospital, Lemnos 187 107 13 sacks

7th Field Ambulance, Polygon Camp, Cairo 4 2

2nd Light Horse Field Ambulance,

Maadi, Cairo 6,056 2

2nd Light Horse, Lemnos 7,985 2

Captain Dunlop, 18th Battalion 37

Captain Williams, Hqrs. 2nd Austr. Division 30

No. 4 Auxiliary Convalescent Depot 754

Heliopolis Dairy Company for 1st A.G.H. 800

Zeitoun Convalescent Camp 2,250 13

6th Light Horse 560

Dr. Hastings 500

No. 17 General Hospital, Alexandria 3,532

Deaconess Hospital, Alexandria 1,733 6

Egyptian Army Hospital, Abbassia 708 6

2nd Indian General Hospital 6,486

Dr. Oulton, Tanta Hospital 3,899

Mustapha Barracks, Alexandria 4,585

New Zealand Mounted Rifles 736 1

Lancashire Fusiliers 1,116

No. 15 General Hospital, Alexandria 4,199

Military Hospital, Cairo 244 1

School Hospital, Port Said 700

Red Cross Hospital, Saideh School 3,456 2

No. 4 Base, Medical Depot, Alexandria 13,032

Convalescent Hospital, Ismailia 1,904

French Convalescent Hospital, Alexandria 2,294

Ordnance Office Base, Alexandria 9,528

European Hospital, Alexandria 740

4th Field Ambulance 1,250

------- ----- ---

Total 411,974 1,357 110

======= ===== ===

LIST OF RED CROSS GOODS SUPPLIED FROM STORE APART FROM OTHER GOODS

PURCHASED AND SUPPLIED

Aprons (surgical) 260

Blankets 5,875

Cholera belts 7,400

Hot-water bottles 407

Bandages 51 cases

" 200

Books 87 pkgs.

Caps 2,010

Caps (surgical) 266

Dressing-gowns 184

Handkerchiefs 46,298

Housewives 776

Cardigan jackets 3,483

Hospital jackets 269

Pneumonia jackets 341

Old linen 90 cases

Mufflers 3,662

Masks (surgical) 24

Nightingales 495

Overalls (surgeons') 243

Pillows 2,945

Pillowslips 24,501

Pyjamas 17,300

Pyjama trousers 881

Pipes 1,570

Quilts 43

Sheets 7,240

Draw sheets 4,032

Shirts (flannel) 24,876

Shirts (cotton) 9,913

Hospital shirts 4,725

Socks 70,725

Bed socks 1,018

Toilet soap 2,789 cakes

" " 4 cases

Slippers 5,878

Towels 43,914

Medical towels 4,183

Undershirts (flannel) 12,333

Underpants (flannel) 5,588

Vaseline 284

Face washers 37,665

Binders 200

Hospital bags 334

Soldiers' kit bags 4,710

Air cushions 17

Tooth brushes 6,885

Tooth paste 1,552

Sea kit bags 717

Hair brushes 1,047

Hair combs 1,081

Ointment 208

Playing cards 723

Pencils 176

Safety pins 380

Rubber sheets 6

Mosquito nets 1,251

Insect powder 314 pkts.

Sponges 2,756

Tobacco 2,379 plugs

" 16 cases

Cigarettes 3,741 pkts.

" 1 case

Biscuits 64 cases

Extract of beef 45 "

Soap 1,120 bars

" 70 cases

Gooseberries 66 "

Glaxo 38 "

Milk 36 "

Beans 20 sacks

Peas 13 "

Jam 172 cases

Syrup 54 "

Tomatoes 51 cases

Milk and cocoa 5 "

" " 69 tins

Pineapples 98 cases

Apricots 49 "

Honey 8 "

Dried apples 47 "

Dried peaches 115 "

Pears 43 "

Foodstuffs 77 "

" 55 pots

Malted milk 6 cases

Chocolate and sweets 2 "

" " 634 "

Extract of malt 3 "

Rolled oats 1 case

Lactogen 7 cases

Ground sheets 22

Cloth caps 2,984

Games 65

Walking-sticks 16 bundles

" 687 loose

Writing-pads 1,206

Envelopes 28,470 pkts.

Lemons 15 cases

Glass towels 325

Sun glasses 108

Hot-water bottle covers 260

Dusters 773

Mattresses 9

Swabs 7 cases

" 500

Candles 1 case

Cane chairs 70

Toilet paper 45 cases

Puddings 1 case

Preserved fruit 47 cases

Linen coats 388

Cushions 115

" 3 cases

Fly whisks 725

" 2 cases

Knives 30

Spoons 95

Wine 8 cases

Deck chairs and camp stools 340

Bales of clothing 25

Brassards 200

Shaving-brushes 1,801

Skin coats 10

Cotton thread 50 reels

Toilet paper 100

Nail brushes 24

Jug covers 100

Mittens 673

GOODS SENT TO LEMNOS

Articles. Cases. Sack.

1st Stationary Hospital, Lemnos 42,333 107 12

2nd " " " 187 107 13

Imbros Rest Camp 650 70

Col. Bryant, for Distribution, Dardanelles 23,236 127 8

2nd Light Horse, Lemnos 7,985 2

AGREEMENT MADE FOR PROVISION OF REFRESHMENTS TO SOLDIERS ON INVALID

TRAINS

1. The Restaurant Car can be placed on the train and the cost of same,

£7 10s., guaranteed by Lieut. Colonel Barrett.

2. Meals will be provided for Commissioned Officers, P.T. 20 lunch or

dinner, P.T. 5 afternoon tea, at stated times.

3. Meals and afternoon tea will be provided for N.C.O.s in the

Restaurant Car at half price.

4. Sandwiches, P.T. 1, and non-alcoholic drinks (soda water, lemonade,

etc.), P.T. 1, will be served in the cars by the attendants of the

Restaurant Car to soldiers who desire to purchase them.

5. In addition, water will be provided in each carriage for the use of

soldiers in fantasses, and lime juice will be supplied, two bottles in

each carriage, free.

Notice to this effect will be posted in every carriage on the troop

train.

_July 1, 1915._

[Illustration: HELIOPOLIS SIDING: ARRIVAL OF WOUNDED.

_To face page 166_]]

12. _Soldiers' Clubs._--Reference has been made in the chapter on

Venereal Diseases to the damage done to Australian troops in Egypt by

venereal disease. Reference has also been made to the establishment of

soldiers' clubs and recreation huts in various places to provide a

counter-attraction to those entertainments furnished by the prostitute

and her degraded male attendants. After the various repressive steps

already referred to had been taken, an earnest attempt was made to

organise this constructive work. The valuable assistance of Mr. Jessop

and the Y.M.C.A. was again invited. The Y.M.C.A. proposed to build in

Alexandria on the sea front a large building to be used as a central

soldiers' club, and to be available for convalescents and the healthy.

The Y.M.C.A. had only £250 available and required £1,000. The British

Red Cross Society was appealed to and hesitated. A cable was dispatched

to London, and an expenditure of £250 authorised. Surgeon-General

Williams, after consultation with His Excellency Sir Henry MacMahon, the

G.O.C.-in-Chief, Sir John Maxwell, and the D.M.S. Egypt, General Ford,

decided to make a grant of £500 in addition for the purpose. The club

was opened on September 12, and from its opening was a pronounced

success. The soldier on leave, tramping about the streets of Alexandria,

gets leg-weary and falls an easy victim to the wiles of the various

agents abroad. He now can visit his own club, where the entry is free to

all men in uniform. He there receives war telegrams, stationery, cheap

and excellent meals, and enjoys various forms of entertainment. He meets

his friends, and can spend the time under the most pleasant conditions.

The building already requires extension, as the pressure on the

accommodation is so great. Similar action was taken in Cairo, where

after many unsuccessful attempts the Rink Theatre in the beautiful

Esbekieh gardens was obtained, owing to the sympathetic help given by

His Excellency Sir Henry MacMahon and other authorities. This open-air

theatre is a little over an acre in extent, and is a valuable property.

It had been leased to a restaurant keeper in the vicinity. Arrangements

were made for the supply of light refreshments at bed-rock prices in the

theatre, and other meals at low prices at the restaurant which is about

fifty yards away. In addition a soldiers' club, managed by ladies, is

equidistant, and at this comfortable resort refreshments are supplied in

quiet rooms at low rates. Naturally the club has become a resort for all

the soldiers in Cairo. Major Harvey, Commissioner of Police, has cleared

the surrounding gardens of undesirable characters. The club was placed

under the management of a joint committee of which Her Excellency Lady

MacMahon is Patroness, and Lady Maxwell is President. The executive

committee consists of three members of the Y.M.C.A., and the expenses of

managing the club were provided by the British Red Cross Society,

Australian Branch, for the first three months. It was soon found that in

order to make the club successful the athletic element must be

developed, and splendid programmes were arranged--boxing, fencing,

skating contests, and the like. The club provides writing-paper, games,

war telegrams, Australian and other newspapers, shower baths, and other

conveniences. As many as 1,500 soldiers are present on some of these

occasions, and the club is visited by officers who periodically drop in

amongst the men. Altogether the success has exceeded even the sanguine

expectations of those who founded it.

The British Red Cross Society, Australian Branch, was most fortunate in

securing such a site, as any one acquainted with the conditions of Cairo

is fully aware.

[Illustration: MATRONS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL.

_To face page 169_]]

The exact extent to which these clubs have contributed to the limitation

of venereal disease cannot be accurately measured, but there is no doubt

whatever in the minds of any one acquainted with the facts respecting

their salutary and healthy influence. Under the new constitution of the

Australian Red Cross money cannot be devoted to their maintenance,

because it is not being used exclusively for the sick and wounded. Such

is the ruling, although many convalescents use the clubs. It is

regrettable that such a rigid ruling should have been established. It is

absurd to permit men to become infected and then to assist them by doles

of chocolate and tobacco, and yet to refuse to provide the necessary

funds which assist so materially in preventing infection.

13. _Nurses' Rest Homes._--The nurses in the hospitals had done

excellent work under trying conditions, and it became obvious that many

of them would break down unless holidays and rest were provided.

The British and Australian Red Cross Branches combined under the

Presidency of Her Excellency Lady MacMahon, and opened two rest

homes--one in Ramleh near the beach, and the other at Aboukir Bay, the

site of Nelson's victory.

They were furnished by the Red Cross Societies and have been maintained

by the Commonwealth Government so far as the Australian nurses are

concerned. They have met a great want and have proved a boon and a

blessing.

_Conclusion._--The work has been very heavy and the circumstances far

from easy. Taking everything into consideration and realising the

pressure at both ends, the result can only be regarded as more than

satisfactory. The policy of the Red Cross Society requires, however,

some consideration.

The policy adopted until lately was that reasonable intimation should be

given to the Red Cross Society of the requirements of those who want

help. Under public pressure another policy may make its

appearance--that of compelling the Red Cross Society to find out what

people want. A word of caution is necessary. This policy will almost

certainly result in the creation of an extensive business organisation

and in the Red Cross undertaking much work which the Government should

do. In my opinion the Red Cross Society is entirely ancillary, its

functions being to provide comforts and other things which the

Government cannot supply, and to act decisively at critical moments. It

should, however, refrain from embarking on great national undertakings.

Every one will endeavour to help the Commissioners in their extensive

and difficult task, and will look forward to the Australian Red Cross

maintaining the high reputation which it has already gained amongst

responsible officers in Egypt.

In conclusion it should be pointed out that during the whole period

under review all necessary services were provided by the military

authorities and the Red Cross was administered on military principles.

Consequently there were no large expenses, no one received any money in

payment for services, and the storage of goods was free.

If the Red Cross is to be administered on non-military lines many

charges must be properly made and met, but the efficiency of the system

instituted and now set aside must be judged largely from the standpoint

of economic administration.

JAMES W. BARRETT,

_Lieut.-Colonel_.

(In this volume the original report forwarded to Melbourne has been

expanded and amplified.)

APPENDIXES

1. _Directions for the Conduct of the Red Cross Depot_

Depot--conduct of. 1. The Depot is placed under

the charge of a Medical

Officer who will have at

his disposal nurses and

orderlies in such numbers

as the work from time to

time may necessitate.

Storage of goods. 2. All goods consigned to the

Red Cross Depot shall be

placed in store at once

and rendered secure under

lock and key at other

than business hours.

Receipt Book. 3. All goods received will be

entered in the Goods Receipt

Book.

Requisitions--how 4. On receipt of requisitions

dealt with. signed by the Officer Commanding

any unit, and

countersigned by the

Officer Commanding

First Australian General

Hospital, goods will be

issued, and if necessary

transport provided. Two

clear lists shall be prepared

on forms provided

for the purpose, one to be

receipted and returned to

Red Cross Depot by the

consignee and duplicate

to be filed in Office.

Stock-taking. 5. A Stock Book is to be kept

showing the nature and

quantity of material received,

and the quantity

distributed, so that at

any time the stock remaining

can be ascertained.

This book to be

checked once a month by

stock-taking of the contents

of the store and

certified to by the M.O.

in charge.

2. _Result of Vote at No. 1 Auxiliary Convalescent Depot_

The following items represent the wishes of 840 patients at Luna Park on

July 29, 1915, ascertained by the O.C., Major Brown.

Four hundred and forty papers were received, a great number of patients

failing to vote.

The patients were asked to make a list of twenty to thirty articles that

would add to their comfort during their stay in hospital, and which

could be supplied by a small fund at his disposal.

The average items on collected lists were 8.

Razors 249

Shaving-sticks 244

Razor strops 241

Toothpaste 221

Cigarette 194

Toilet soap 188

Matches 170

Mirrors 177

Shaving-brushes 163

Tooth-brushes 148

Handkerchiefs 131

Tobacco 121

Pipes 106

Hairbrushes 99

Writing material 98

Haircombs 96

Fruit 63

Chocolate 54

Socks 37

Sweets 32

Pocket knives 30

Playing cards 21

Lead pencils 19

Housewives 14

Cigars 11

Biscuits 10

Walking-sticks 8

Shirts 8

Singlets 7

Belts 6

Tobacco pouches 4

Fountain pens 3

Bottles of ink 3

Nail brushes 3

Boot laces 3

Post cards 3

Mouth organs 3

Cigarette holder 1

Cigarette lighter 1

" papers 1

Sponge 1

Pair scissors 1

Soap box 1

Nuts 1

Dark eye-glasses 1 pair

Blades for safety razors 1 set

Notebook 1

3. _Fence or Ambulance?_

Some critics have objected to the Red Cross assisting Soldiers' Clubs.

The following lines are commended to their notice. But for the

Australian Branch British Red Cross there would have been no such

Soldiers' Clubs as those provided at Esbekieh and Alexandria.

[Illustration: SOLDIERS' CLUB, ESBEKIEH, CAIRO.

_To face page 174_]]

'Twas a dangerous cliff, as they freely confessed,

Though to walk near its crest was so pleasant;

But over its terrible edge there had slipped

A duke, and full many a peasant.

So the people said something would have to be done,

But their projects did not at all tally:

Some said, "Put a fence round the edge of the cliff";

Some, "an ambulance down in the valley."

But the cry for the ambulance carried the day,

For it spread through the neighbouring city,

A fence may be useful or not, it is true,

But each heart became brimful of pity

For those who had slipped over that dangerous cliff;

And the dwellers in highway and alley

Gave pounds or gave pence, not to put up a fence,

But an ambulance down in the valley.

"For the cliff is all right if you're careful," they said,

"And if folks even slip and are dropping,

It isn't the slipping that hurts them so much

As the shock down below when they're stopping."

So day after day, as those mishaps occurred,

Quick forth would these rescuers sally

To pick up the victims who fell off the cliff,

With the ambulance down in the valley.

Then an old sage remarked, "It's a marvel to me

That people give far more attention

To repairing results than to stopping the cause

When they'd much better aim at prevention.

Let us stop at its source all this mischief," cried he,

"Come, neighbours and friends, let us rally!

If the cliff we will fence we might almost dispense

With the ambulance down in the valley."

"Oh, he's a fanatic," the others rejoined.

"Dispense with the ambulance? Never!

He'd dispense with all charities, too, if he could!

No, no! We'll support them for ever!

Aren't we picking folks up just as fast as they fall?

And shall this man dictate to us? Shall he?

Why should people of sense stop to put up a fence

While their ambulance works in the valley?"

But a sensible few, who are practical too,

Will not bear with such nonsense much longer;

They believe that prevention is better than cure,

And their party will soon be the stronger.

Encourage them, then, with your purse, voice, and pen,

And (while other philanthropists dally)

They will scorn all pretence, and put a stout fence

On the cliff that hangs over the valley.

Better guide well the young than reclaim them when old,

For the voice of true wisdom is calling:

"To rescue the fallen is good, but 'tis best

To prevent other people from falling.

Better close up the course of temptation and crime

Than deliver from dungeon or galley;

Better put a strong fence round the top of the cliff,

Than an ambulance down in the valley."

JOSEPH MALINES.

THE RED CROSS POLICY: WANTED, A DEFINITION

Before leaving consideration of the details of the Red Cross question,

attention should be directed to the numerous changes in the policy

adopted by the British Red Cross Society, Australian Branch. No less

than three different types of administration were rapidly adopted. It

was first placed in the hands of Surgeon-General Williams and the High

Commissioner for Australia, in London; then it was placed under a

committee in Egypt formed by the High Commissioner for Egypt, Sir Henry

MacMahon, and six weeks later two Commissioners were appointed to take

the work over. Nothing more clearly illustrates the state of mental

instability in which a first experience of war had thrown the population

of Australia. The policy which was adopted by Surgeon-General Williams

in connection with the Red Cross administration is that which we believe

to be sound.

When acting as A.D.M.S. to the Australian Force in Egypt it became my

duty (Lieut.-Col. Barrett) to sanction or modify the requisitions of

medical stores for the various hospitals and units, and the instructions

conveyed to me were that I could sanction any requisition provided that

it was reasonable. If, however, it represented a new departure it must

be authorised by the D.M.S. Egypt. This meant practically that

everything could be obtained from Ordnance, and many of the Red Cross

supplies became superfluous. That is to say, any necessary goods in the

Red Cross store were utilised, but if they had not been there the

Government would have purchased them. In fact, it reduced the field in

which the Red Cross could operate to comparatively small proportions.

There is no doubt that, had it become necessary, I should have

authorised the erection of shelter sheds and recreation huts in the

various hospitals as a medical necessity. There was one advantage, and

one advantage alone, in effecting these changes with the aid of the Red

Cross. The action if sanctioned by superior officers could not be

challenged by any one else at the time, and could be effected with

extraordinary speed.

I took the view that it was the business of the Officer Commanding the

hospital, with the aid of the matron, sisters, and medical officers, to

let me know what was thought necessary, and unless the requirement was

outrageous it was immediately supplied. As a matter of fact no single

request for money or goods was ever refused or seriously modified. Owing

to pressure of public criticism another policy began to make its

appearance. It was asserted that it was the duty of the Red Cross

officer to visit the various hospitals to find out what the patients

ought to receive. It will be seen that such a policy removed from the

O.C.s of the hospitals, or any one to whom they may have delegated their

powers, the responsibility for determining what patients should receive.

Such a policy sooner or later must result in the creation of an army of

people who are worrying to find out what they can do instead of being

properly instructed by those responsible for the welfare of the

patients.

It further tended to place in the hands of irresponsible people some

control over the medical management of hospital cases. If lay visitors

can enter a hospital and provide food for patients, they may next wish

to provide drugs, etc. It seemed that the policy laid down in the first

instance was sound, useful, and healthy.

When the Commissioners took office they made a number of changes in

detail. They shifted the position of the store; they printed different

forms of requisition, and they took the goods out of the quartermaster's

store and placed them in a store in the hospital, presided over by a

volunteer. The goods were then obtained by requisition from the sisters

and the matron. But as the President of the Red Cross Inquiry Court

pointed out, with one trifling exception the method was not really

altered. The control had simply ceased to be military, and had become

civil. Consequently a large staff of capable people were withdrawn from

their ordinary occupations in Australia, and devoted themselves to an

administration which had been hitherto effected entirely by the

soldiers. We do not think that the change was right or desirable. It

resulted in the creation of another body, not responsible directly to

the military authorities, to do what is after all subsidiary work. The

inevitable tendency will be for the Red Cross to take on function after

function which should be undertaken by military authorities. The Red

Cross is already supplying many articles which should be, and can be,

supplied by Ordnance. For there is nothing that the Red Cross can supply

that Ordnance cannot still more easily supply. It is quite true that the

British Red Cross is managed on civil lines, and the British Red Cross

supplies goods and does not supply money. But with a full knowledge of

both systems we are strongly of opinion that the military method of

management is in every respect preferable.

During the Red Cross Inquiry recently finished, to which allusion will

be made elsewhere, day after day was necessarily spent by the Court in

endeavouring to decide what Red Cross should supply and what Ordnance

should supply. What does it matter so long as the patient receives the

articles? It does not concern him where they come from, and if the whole

is under military control there is no need for this sharp and artificial

line of demarcation. We are of opinion that in general the functions of

the Red Cross should be to supply those additional comforts and

accessories which make sick life more tolerable, to supply any goods

which may be donated, and to make helpful donations of money in the way

already indicated.

The presence in the store at Heliopolis of large quantities of

goods--sheets, blankets, pillows, and the like--which could have been

supplied by Ordnance, enabled us to rapidly tide over a great emergency.

There is no doubt that the possession of money and goods by the Red

Cross will prove of vast service in every campaign by reason of its

emergency value. In fact the rapid expansion of No. 1 General Hospital

during the crisis of May and June would not have proceeded with such

smooth expedition had it not been for the large quantities of Red Cross

stores which lay to hand and were instantly passed into the

Quartermaster's department. If, however, the supply had been under lay

control, we can quite imagine circumstances in which argument,

requisitions, forms, etc., might have seriously delayed operations.

Whilst on this subject reference must be made to the help afforded to

the hospitals by Red Cross workers. Two schools of thought existed. Some

Commanding Officers preferred to have no helpers, because of the trouble

some of them gave. Others passed to the other extreme. Our own

experience was that the workers organised by Mrs. Elgood were most

helpful for the functions they undertook, with one or two exceptions,

but those exceptional people gave a certain amount of trouble. They came

not to help, but to criticise, and they carried their criticisms not to

the Commanding Officer, but to the Australian public, and so caused

trouble.

We are convinced that the Japanese method of organising the Red Cross is

sound. It is organised and disciplined in time of peace, and when war is

declared it becomes part of the army medical reserve and is mobilised

for service. Every one is under military control, and consequently

these crudities are avoided. If we were to repeat our experience we

should have welcomed the visitors, but insisted that they should be

under some measure of discipline, and that a serious breach of

regulations should be followed by their withdrawal. In some instances

visitors wrote to the Commander-in-Chief, and complained of the food the

patients were getting. The Commander-in-Chief sent the letters on to us,

and we then brought the visitor in contact with the Commanding Officer

of the hospital, and the complaint was investigated. How much more

direct and simple it would have been if the visitor who saw something he

believed to be wrong had immediately asked for the Officer Commanding!

But the "secret and confidential" candid friend is apt to become

somewhat of a pest.

There is another and more serious aspect of the matter. The medical

officer is alone competent to judge what food should be issued to

patients. Visitors who criticise the diet of the patient are assuming a

function which they are obviously unable to discharge. Diet sheets are

provided for each ward, and on these is entered the number of different

diets prescribed by the medical officer. These diet sheets should be the

only and the final authority of what should be issued to the patient in

the way of eatables. As it happened, ladies sometimes brought into the

different wards of the hospital foods which constituted an added danger

to the patient. On one occasion green melons were issued to a large

number of sick men by kind-hearted visitors. The men became so ill that

the medical officer confiscated the melons, made inquiries, and only

then ascertained the source of supply. A strong-looking soldier on a

milk diet might evoke the sympathies of a lady visitor, who lodged a

complaint regarding the supply of food, but the nature of his disease

and the method of treatment adopted by his medical officer are surely

the principal consideration. As everything conceivable in the nature of

food and drink can be supplied through these diet sheets, the obvious

course is to pass all Red Cross foodstuffs directly into the

Quartermaster's department to be distributed in the ordinary, and the

only safe, channel. This was the practice followed at Heliopolis.

The following articles were supplied in this way at the time of

expansion, and show what assistance a properly controlled Red Cross

system can render.

QUARTERMASTER'S REPORT BY LIEUTENANT P. E. DEANE

ASSISTANCE RENDERED THE FIRST AUSTRALIAN

GENERAL HOSPITAL BY RED CROSS IN HOSPITAL

EXPANSION

_April_

Skating Rink opened.

Abbassia Venereal Diseases Hospital opened.

Casino Infectious " " "

The following were obtained immediately on requisition on Red Cross:

Sheets 1,684

Pillowslips 2,300

Face washers 1,600

Towels 2,622

Handkerchiefs 1,000

Blankets 61

Pyjamas 489

Cotton shirts 701

Underpants 400

Socks 600

Flannel shirts 400

Slippers 67

Draw sheets 500

Pillows 69

Quilts 12

Old linen cases 2

_May_

Great rush of patients--Luna Park expanded, Palace Hotel expanded.

Patients admitted in four days from

April 29 to May 2 1,543

Patients admitted during May 2,650

RED CROSS SUPPLIES

Sheets 1,381

Blankets 1,038

Towels 4,394

Pyjamas 1,176

Shirts 238

Handkerchiefs 500

Face washers 1,000

_June_

Rush of wounded continues. Atelier occupied, Sporting Club commenced.

Patients admitted during June 2,862

RED CROSS SUPPLIES

Pyjamas 790

Face washers 1,000

Sheets 900

Towels 1,500

Sponges 1,500

Handkerchiefs 1,500

Cotton shirts 950

Socks 1,000

Slippers 500

Pillowslips 1,000

Special hospital organised hurriedly by the department on June 17.

Ras el Tin Convalescent Home, Alexandria.

RED CROSS SUPPLIES

Socks 1,000

Shirts 1,500

Pyjamas 750

Sheets 750

Blankets 750

Pillowslips 750

Face washers 1,500

_July_

Wounded still pour in. Sporting Club increased by addition of

tennis court wards, Atelier and Luna Park accommodation

increased.

Patients admitted in July 2,194

RED CROSS SUPPLIES

Sheets 2,000

Slippers 1,000

Pillowslips 3,400

Blankets 1,900

Shirts 2,000

Handkerchiefs 2,000

Towels 3,000

Socks 3,400

Face washers 3,000

_August_

Choubra Infectious Hospital hurriedly established and equipped

by the department; 400-bed tent hospital added to Sporting Club.

RED CROSS SUPPLIES

Blankets 2,000

Cotton sheets 1,800

Towels 1,700

Handkerchiefs 2,400

Face washers 2,300

Socks 2,800

Pillowslips 214

CHAPTER X

SUGGESTED REFORMS--DEFECTS WHICH BECAME OBVIOUS IN

WAR-TIME--RECOMMENDATIONS TO PROMOTE EFFICIENCY--DANGERS TO BE

AVOIDED--CONCLUSION.

CHAPTER X

The experience gained in connection with the establishment and extension

of the First Australian General Hospital suggests modifications which

should immensely increase efficiency. A base hospital modelled on the

R.A.M.C. pattern may work exceedingly well in times of peace, or when

staffed by R.A.M.C. or I.M.S. officers who have devoted their whole

lives to the work. But base hospitals constructed during a great war,

and staffed almost entirely with civilian elements the majority of whom

are untrained in administration of any kind, do not work in all cases

with the necessary degree of smoothness. It certainly does appear that

changes in the base hospital establishment might be introduced with

advantage.

In the first place there arises the question whether it is necessary for

the Commanding Officer to be a medical practitioner, or whether, as in

the case of the convalescent hospitals, he might be a combatant officer,

or at all events a non-medical officer. The general consensus of opinion

is that he should be a medical officer, though there is a great deal to

be said on the other side. Almost the whole of his work is

administrative, though he necessarily must have a good knowledge of

clinical methods. But unless such an officer be selected not simply with

regard to seniority, but with regard to experience in administrative

methods, and unless he be tactful and watchful, troubles are very likely

to ensue. His task is beset with difficulties if he possesses character

and insists on efficiency. Whatever doubt there may be, however, about

the Commanding Officer, there need be none about many of the other

positions. A noteworthy feature of the First Australian General Hospital

was the continual complaint from the medical officers that they had not

come away to do administrative work. This distaste for administrative

work was a constant source of trouble.

The Registrar, as the principal executive officer of the hospital, whose

business it is to carry out the decisions of the Commanding Officer, is

at present invariably a medical officer. The greater part of his work

does not need medical knowledge, and the difficulty might be obviated by

the adoption of one of two methods. Either the Registrar might be an

educated business man or he might have such a one as his immediate

understudy. In the latter event a very small portion of his day would be

taken up with the duties of the Registrar's office.

Similarly the orderly officer, whose business it is to deal with details

concerning the rank and file, is usually a medical officer, and in some

hospitals it is the practice to change this officer from day to day. At

No. 1 General Hospital, however, his functions were so important that

one medical officer was permanently told off to do this work. There is

no doubt that the orderly officer need not be a medical officer, and

might well be an invalided combatant officer, transferred to the army

medical service.

Owing to modern developments another officer has made his appearance

who is not provided for in any establishment--that is, the transport

officer. Motor transport has become so large a portion of the work of

the base hospital that a special officer is requisite for the purpose.

There is no reason whatever why such an officer should be a medical man.

If these changes were made it would result in releasing at least three

officers for clinical purposes.

The amount of clerical work that was necessitated by the returns

furnished to the War Office, the Australian Government, Headquarters

Egypt, and other departments was so great that a large staff of very

competent clerks was required. The future establishment should certainly

include not only a number of trained stenographers, but some one versed

in statistical work. The lessons to be learned are so numerous and so

important that something of the kind should be done. Furthermore, in the

Quartermaster's department there was a demand not only for

stenographers, but for men who had been accustomed to the methodical

ways of a large warehouse.

Were all these changes made there is no doubt that the efficiency of the

administration would be increased and the burden of the work lightened.

As regards clinical work other desirable changes might be made. Senior

men who have been in full practice, and who come to a base hospital as

physicians or surgeons with the rank of lieutenant-colonel, are apt to

be entrusted with the detailed administration of medical or surgical

wards. They are often unfitted by training for such administration and

are frequently disinclined to undertake the work. It would be far

better to leave the actual detailed administration of the wards in the

hands of a comparatively junior man with the rank of major, and to

retain these senior officers as consultants only. Consultants of course

possess great powers, since their authority as regards the clinical work

itself is absolute. They can do as much or as little as they like, but

they are in complete control and are absolutely responsible for the

treatment of the cases. Our own feeling is that in such a position they

would be far more comfortable and would be more efficient.

On the subject of specialists there is much to be said. It is almost

incredible that a base hospital should have been formed without being

provided with an ophthalmic and aural specialist. The change has been

made since war began, but it seems inconceivable that any one should

have contemplated the efficient handling of wounds and diseases without

such aid. At the First General Hospital the ophthalmic and aural

department was the largest and most heavily worked department in the

hospital, partly owing to the fact that one of us had been appointed

Consulting Oculist to the Forces in Egypt, and that much of the work

consequently centred at Heliopolis.

Similarly the failure of the Australian Government to provide dentists

in the first instance is difficult to understand. The day has gone by

when it is possible to exclude from the force a man who possesses

dentures or defective teeth, and it is practically impossible to

complete the work for the recruits before they leave. So it became

necessary at No. 1 General Hospital to borrow two dentists from the New

Zealand Government, to fit them out with Red Cross money and goods, and

in this way to meet informally the difficulty. Subsequently the

Australian Government appointed a corps of dentists, and the problem was

to some extent solved, though even now the demand far exceeds the

supply. There is no doubt that dentists are wanted not only at the base

hospitals, but also near the firing line, as the dispatch of a man from

the firing line to the base hospital to obtain dental treatment

represents a waste of time and money.

It is further desirable to attach one or more anæsthetists to every

hospital.

It must, however, be said that the constant changes of staff which took

place at No. 1 Hospital owing to the various exigencies of the military

situation rendered it extremely difficult to keep a physician or surgeon

in any fixed position for any length of time. Consequently a certain

amount of pliability and adaptability was absolutely necessary. At the

same time, if the organisation were sketched in the manner indicated,

the problem would have been more simple, and good results easier to

obtain.

There is no doubt that one medical officer (who could be attached to the

Pathological Laboratory in addition to the Clinical Pathologist) should

devote himself entirely to sanitary work. This duty is not taken too

seriously, and should be emphasised. It would really be better to rename

this officer the "Prophylactic Officer," unless a better term can be

found, and it should be his aim and duty, not simply to enforce

cleanliness, but to actively exert himself to ward off disease.

Stress may be laid on the usefulness of a sensible chaplain, whose

value depends on his own interpretation of his duties. The chaplain

(Colonel Kendrew) at No. 1 General Hospital not only attended to the

religious needs of men, but earned their affection and respect by

managing the extensive post office and library, the canteen, and by

helping with Red Cross work. It is just these badly defined functions in

a base hospital which a chaplain can discharge so well.

We think also that women might be used in base hospitals as

stenographers, ward maids, telephone operators, and the like. Base

hospitals in the future are not likely to be housed in tents, and under

rough conditions. At present, trained nurses are sent to the Stationary

Hospitals. It seems a pity to waste fine young men, who could be

combatants, as orderlies in a base hospital.

Masseurs are certainly badly wanted in a base hospital, and it is

difficult to understand the objection to their incorporation. The

difficulty was removed in Egypt by employing Egyptians.

Electricians, _i.e._ orderlies who in civil life are electricians, are

required in every base hospital, and at Heliopolis they were invaluable

for general purposes, and as aids to the radiographer. They should,

however, form part of the establishment, and should number two or three.

Is it not clear that chefs, laundrymen, skilled carpenters, and other

tradesmen are also required?

The table which follows represents the establishment of the ordinary

520-bed hospital, R.A.M.C. It has been adopted by Australia, but the

Australian establishment allows for 93 nurses instead of 43. If the

foregoing suggestions are adopted, as we think they should be, this

table would require material alteration.

A GENERAL HOSPITAL (520 BEDS)

WAR ESTABLISHMENTS

----------------------+---------------------------------------------------

¦ PERSONNEL.

DETAIL. +---------+----+-----------+--------+--------+------

¦Officers.¦W.O.¦St. Sergts.¦Buglers.¦Rank and¦Total.

¦ ¦ ¦and Sergts.¦ ¦ File. ¦

----------------------+---------+----+-----------+--------+--------+------

Lieut.-Col. in charge ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1

Lieut.-Cols. ¦ 2 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2

Majors-- ¦ ¦ ¦ ¦ ¦ ¦

Sec. and Registrar ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1

General Duties ¦ 4 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 4

Captains or Subs. ¦ 12 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 12

Quartermaster ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1

Warrant Officers ¦ -- ¦ 2 ¦ -- ¦ -- ¦ -- ¦ 2

Sergeants-- ¦ ¦ ¦ ¦ ¦ ¦

Nursing Duties ¦ -- ¦ -- ¦ 4 ¦ -- ¦ -- ¦ 4

Steward ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1

Dispenser ¦ -- ¦ -- ¦ 2 ¦ -- ¦ -- ¦ 2

Cook ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1

Pack Storekeeper ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1

Linen " ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1

Clerks ¦ -- ¦ -- ¦ 3 ¦ -- ¦ -- ¦ 3

Buglers ¦ -- ¦ -- ¦ -- ¦ 2 ¦ -- ¦ 2

Corporals-- ¦ ¦ ¦ ¦ ¦ ¦

Steward ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

Cook ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

Clothing Storekeeper¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

General Duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

Supernumeraries ¦ -- ¦ -- ¦ -- ¦ -- ¦ 3 ¦ 3

Privates-- ¦ ¦ ¦ ¦ ¦ ¦

Steward's Stores ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 ¦ 2

Cooks ¦ -- ¦ -- ¦ -- ¦ -- ¦ 3 ¦ 3

Pack Stores ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

Linen " ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

Clothing " ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1

Clerks ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 ¦ 2

Ward duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 66 ¦ 66

Batman ¦ -- ¦ -- ¦ -- ¦ -- ¦ 25 ¦ 25

General Duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 11 ¦ 11

Supernumeraries ¦ -- ¦ -- ¦ -- ¦ -- ¦ 6 ¦ 6

----------------------+---------+----+-----------+--------+--------+------

TOTAL ¦ 21 ¦ 2 ¦ 13 ¦ 2 ¦ 126 ¦ 164

----------------------+---------+----+-----------+--------+--------+------

With reference to the duties of N.C.O.s and men, nothing gave more

trouble than the fact that men recruited in Australia were made N.C.O.s

before their special qualifications were known. There is no officer in

the Army whose position is so thoroughly safeguarded as the N.C.O., and

nothing but the adverse decision of a court martial can effect his

removal. Yet an unsuitable and even dangerous man, from the point of

view of the sick, may do nothing to warrant a court martial (which no

one enjoys). These appointments should be made therefore with great

care. Such considerations, of course, lead to but one conclusion, viz.

the necessity for sketching out these hospitals in time of peace.

Scratch enlistments are too dangerous.

The "grouser" is always with us, and sometimes gives trouble. The

particular Australian "grouse" was that the Australian hospitals should

have been nearer the front than Cairo, and at last No. 3 Australian

General Hospital was placed at Mudros.

Now we have always understood that a large base hospital cannot be

placed far from a great city. A city grows in a particular place for

natural reasons--water supply, lighting, transit, etc. The hospital gets

the benefit of all these agencies, whereas it was necessary at Lemnos to

create them. The result was somewhat disastrous as regards supplies, and

might have been foreseen.

"Grousers" should stay at home, and exercise their privileges there.

The difficulties of obtaining supplies by requisition were easily

surmounted at Heliopolis because of the broad policy adopted by the

Officer Commanding the Australian Intermediate Base, Colonel Sellheim,

C.B.

[Illustration: N.C.O.S AND MEN, NO. 1 AUSTRALIAN GENERAL HOSPITAL.

_To face page 197_]]

Ordnance cannot supply the varied requirements of a group of expert

medical officers during a great war, and delays cause untold annoyance

to active men. On the other hand, it would never do to give the staff a

free hand to purchase when and how it pleased.

The institution of "local purchase orders" met the difficulty. The O.C.

of the hospital sent in a requisition for something which could not be

obtained from Ordnance, marking it "urgently required." The A.D.M.S.

endorsed it, or, if it were an entirely new line, asked the D.M.S. to

endorse it. The Ordnance officer then issued a local purchase order to

the medical officer, who made the purchase. The method combined a

measure of control with reasonable speed in execution.