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diff --git a/41911-0.txt b/41911-0.txt new file mode 100644 index 0000000..994218e --- /dev/null +++ b/41911-0.txt @@ -0,0 +1,8324 @@ +*** START OF THE PROJECT GUTENBERG EBOOK 41911 *** + + AUSTRALIAN ARMY + MEDICAL CORPS + IN EGYPT + + BARRETT and DEANE + + + + + THE AUSTRALIAN ARMY + MEDICAL CORPS IN EGYPT + + + + +[Illustration: HELIOPOLIS PALACE HOTEL SHOWING ROTUNDA AND PIAZZAS. +_Frontispiece_]] + + + + + THE AUSTRALIAN ARMY + MEDICAL CORPS IN EGYPT + + AN ILLUSTRATED AND DETAILED ACCOUNT OF + THE EARLY ORGANISATION AND WORK OF THE + AUSTRALIAN MEDICAL UNITS IN EGYPT + IN 1914-1915 + + BY + + JAMES W. BARRETT + K.B.E., C.M.G., M.D., M.S., F.R.C.S. (ENG.) + TEMPORARY LIEUT.-COL. R.A.M.C. + + LATELY LIEUT.-COL. A.A.M.C. AND A.D.M.S. AUSTRALIAN FORCE IN + EGYPT, CONSULTING OCULIST TO THE FORCE IN EGYPT AND REGISTRAR + FIRST AUSTRALIAN GENERAL HOSPITAL; OPHTHALMOLOGIST TO THE + MELBOURNE HOSPITAL, LECTURER ON THE PHYSIOLOGY OF THE SPECIAL + SENSES IN THE UNIVERSITY OF MELBOURNE + + AND + + LIEUT. P. E. DEANE, A.A.M.C. + + QUARTERMASTER FIRST AUSTRALIAN GENERAL HOSPITAL, EGYPT + + H. K. LEWIS & CO. LTD. + 136 GOWER STREET, LONDON, W.C.1 + 1918 + + + + + DEDICATED TO + SIR HENRY AND LADY MACMAHON, + IN GRATEFUL RECOLLECTION + OF THE SERVICES RENDERED BY THEM + TO THE + AUSTRALIAN SICK AND WOUNDED + IN EGYPT + + + + + CONTENTS + + + CHAPTER I + THE AUSTRALIAN ARMY MEDICAL CORPS AT THE OUTBREAK OF WAR + The Call for Hospitals--Appeal to the Medical Profession, and + the Response--Raising the Units pp. 1-10 + + CHAPTER II + THE VOYAGE OF THE "KYARRA" + Lack of Adequate Preparation--Difficulties of + Organisation--Ptomaine Poisoning pp. 11-18 + + CHAPTER III + ARRIVAL AND SETTLEMENT IN EGYPT + Disposal of the Hospital Units--Treatment of Camp Cases--The + Acquisition of Many Buildings--Where the Thanks of Australia + are Due pp. 19-31 + + CHAPTER IV + THE RUSH OF WOUNDED AND RAPID EXPANSION OF HOSPITALS + Saving the Situation--Period of Improvisation--Shortage of + Staff and Equipment--How the Expansion was effected--The Number + of Sick and Wounded pp. 33-54 + + CHAPTER V + CONVALESCENT DEPOTS + Evacuation of Convalescent Sick and Wounded from Congested + Hospitals--Keeping the Hospitals Free--Libels on the Egyptian + Climate--Discipline pp. 55-65 + + CHAPTER VI + EVACUATION OF THE UNFIT + Relieving the Pressure on the Hospitals and Convalescent + Depots--Back to Duty or Australia--Methods adopted--Transport + of Invalids by Sea and Train pp. 67-81 + + CHAPTER VII + SICKNESS AND MORTALITY AMONGST AUSTRALIANS + The Dangers of Camp Life--Steps taken to prevent + Epidemics--Nature of Diseases contracted and Deaths + resulting--Defective Examination of Recruits--Ophthalmic and + Aural Work--The Fly Pest--Low Mortality--The Egyptian Climate + again--Surgical Work and Sepsis--Cholera--Infectious Diseases + pp. 83-111 + + CHAPTER VIII + VENEREAL DISEASES + The Greatest Problem of Camp Life in Egypt--Conditions in + Cairo--Methods taken to limit Infection--Military and Medical + Precautions--Soldiers' Clubs pp. 113-133 + + CHAPTER IX + THE RED CROSS WORK + Its Value and Limitations--Origin in Australia--Report of + Executive Officer in Egypt--Red Cross Policy--Defects of Civil + and Advantages of Military Administration--What was actually + done in Egypt pp. 135-185 + + CHAPTER X + SUGGESTED REFORMS + Defects which became Obvious in War-time--Recommendations to + promote Efficiency--Dangers to be avoided--Conclusion pp. 187-205 + + CHAPTER XI + POSTSCRIPT + Closure of Australian Hospitals--The Fly Campaign--Venereal + Diseases--Y.M.C.A. and Red Cross--Multiplicity of + Funds--Prophylaxis--Condition of Recruits on Arrival--Hospital + Organisation--The Help given by Anglo-Egyptians pp. 206-234 + + + APPENDIXES + + I + Translation of Geneva Convention of July 6, 1906 pp. 237-246 + + II + Convention for the Adaptation of the Principles of the Geneva + Convention to Maritime War pp. 247-256 + + INDEX pp. 257-259 + + + + + LIST OF ILLUSTRATIONS + + + HELIOPOLIS PALACE HOTEL, SHOWING ROTUNDA AND + PIAZZAS _Frontispiece_ + + FACING PAGE + MENA CAMP 6 + THE S.S. "KYARRA" 14 + HELIOPOLIS PALACE HOTEL, SHOWING INFECTIOUS DISEASES CAMP 22 + PLAN OF HELIOPOLIS PALACE HOTEL 23 + THE MAIN HALL, HELIOPOLIS PALACE HOTEL 24 + SURGICAL WARD, HELIOPOLIS PALACE HOTEL 25 + HELIOPOLIS PALACE HOTEL: ISOLATION TENTS 26 + THE RINK, LUNA PARK, HELIOPOLIS 27 + THE CASINO, HELIOPOLIS: INFECTIOUS DISEASES HOSPITAL 29 + THE PAVILION, LUNA PARK, HELIOPOLIS 30 + THE ATELIER, HELIOPOLIS 37 + THE SPORTING CLUB, HELIOPOLIS 40 + THE FLEET OF AMBULANCES, HELIOPOLIS 42 + THE OPERATING ROOM, HELIOPOLIS PALACE HOTEL 44 + UNLOADING THE HOSPITAL TRAIN, HELIOPOLIS SIDING 47 + THE LAKE, LUNA PARK, HELIOPOLIS 49 + THE SPORTING CLUB, HELIOPOLIS 51 + THE SPORTING CLUB, HELIOPOLIS 52 + CAIRO AND NEIGHBOURHOOD 58 + HELIOPOLIS PALACE HOTEL: CONVALESCENTS ON PIAZZA 59 + THE EASTERN MEDITERRANEAN 77 + EGYPT, THE DELTA 80 + OFFICERS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL 86 + HELIOPOLIS PALACE HOTEL: ROTUNDA AND PIAZZAS 97 + VENEREAL DISEASES HOSPITAL, ABBASSIA 120 + SOLDIERS' CLUB, ESBEKIEH, CAIRO 133 + HELIOPOLIS PALACE HOTEL 141 + INTERIOR RED CROSS STORE: UTILISATION OF CASES FOR SHELVING 144 + RED CROSS BASE DEPOT, HELIOPOLIS 148 + HELIOPOLIS SIDING: ARRIVAL OF WOUNDED 166 + MATRONS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL 169 + SOLDIERS' CLUB, ESBEKIEH, CAIRO 174 + N.C.O.S AND MEN, NO. 1 AUSTRALIAN GENERAL HOSPITAL 197 + PALACE OF PRINCE IBRAHIM KHALIM (NURSES' HOME) 198 + GORDON HOUSE, HELIOPOLIS (NURSES' HOME) 200 + AUSTRALIAN CONVALESCENT HOSPITAL, AL HAYAT, HELOUAN 204 + + + + + INTRODUCTION + + +The experience of the Australian Army Medical Service, since the +outbreak of war, is probably unique in history. The hospitals sent out +by the Australian Government were suddenly transferred from a position +of anticipated idleness to a scene of intense activity, were expanded in +capacity to an unprecedented extent, and probably saved the position of +the entire medical service in Egypt. + +The disasters following the landing at Gallipoli are now well known, and +the following pages will show how well the A.A.M.C. responded to the +call then made upon it. + +When the facts are fully known, its achievements will be regarded as +amongst the most effective and successful on the part of the +Commonwealth forces. + +In the following pages we have set out the problems which faced the +A.A.M.C. in Egypt, regarding both Red Cross and hospital management, the +necessities which forced one 520-bed hospital to expand to a capacity of +approximately 10,500 beds, and the manner in which the work was done. + +The experience gained during this critical period enables us to indicate +a policy the adoption of which will enable similar undertakings in +future to be developed with less difficulty. + +We desire to acknowledge gratefully the permission to publish documents +granted by General Sir William Birdwood and Dr. Ruffer of Alexandria, +and also much valuable help given by Mr. Howard D'Egville. + +The beautiful photographs which are reproduced were mostly taken by +Private Frank Tate, to whom our best thanks are due. + +In any reference to the work of the Australian Army Medical Corps in +Egypt it must never be forgotten that the expansion of No. 1 Australian +General Hospital was effected under the personal direction of the +officer commanding, Lieut.-Colonel Ramsay Smith, who was responsible for +a development probably unequalled in the history of medicine. + +The story told is the outcome of our personal experience and +consequently relates largely to No. 1 Australian General Hospital, with +which we were both connected. + + + + + CHAPTER I + + THE AUSTRALIAN ARMY MEDICAL CORPS AT THE OUTBREAK OF WAR--THE + CALL FOR HOSPITALS--APPEAL TO THE MEDICAL PROFESSION AND THE + RESPONSE--RAISING THE UNITS. + + + + + CHAPTER I + + +Prior to the outbreak of war in August 1914, the Australian Army Medical +Corps consisted of one whole-time medical officer, the Director-General +of Medical Services, Surgeon-General Williams, C.B., a part-time +principal medical officer in each of the six States (New South Wales, +Victoria, and Queensland, South Australia, Western Australia, and +Tasmania), and a number of regimental officers. With the exception of +the Director-General, all the medical officers were engaged in civil +practice, which absorbed the greater portion of their energy. + +The system of compulsory military training which came into operation in +1911 was creating a new medical service, by the appointment of Area +Medical Officers, whose functions were to render the necessary medical +services in given areas, apart from camp work. These also were mostly +men in civil practice, to whom the military service was a supplementary +means of livelihood. + +Camps were formed at periodical intervals for the training of the +troops, the duration of the camps rarely exceeding a week. At these +camps a certain number of regimental medical officers were in +attendance, and were exercised in ambulance and field-dressing work. + +In common with the members of other portions of the British Empire, few +medical practitioners in Australia had regarded the prospect of war +seriously, and in consequence the most active and influential members of +the profession, with some notable exceptions, held aloof from army +medical service. + +In 1907, however, owing to the representations of Surgeon-General +Williams, and to the obvious risk with which the Empire was threatened, +senior members of the profession volunteered and joined the Army Medical +Reserve, so that they would be available for service in time of war. The +surgeons and physicians to the principal hospitals received the rank of +Major in the reserve, and the assistant surgeons and assistant +physicians the rank of Captain. Some attempt was made to give these +officers instruction by the P.M.O's, but the response was not +enthusiastic, and little came of it. + +At the same time there were a number of medical officers in the +Australian Army Medical Corps who possessed valuable experience of war, +notably the Director-General, whose capacity for organisation evidenced +in South Africa and elsewhere made for him a lasting reputation. The +Principal Medical Officer for Victoria, Colonel Charles Ryan, had served +with distinction in the war with Serbia in 1876, and in the war between +Russia and Turkey in 1877. A fair number of the regimental officers had +seen service in South Africa. The bulk of the medical practitioners +concerned, however, had not only no knowledge of military duty, but +certainly no conception whatever of military organisation and +discipline; and what was still more serious, no real and adequate +realisation of the extraordinary part that can be played in war by an +efficient medical service by prophylaxis. + +Such, then, was the position when war was declared. + +The response from the people throughout Australia was, as Australians +expected, practically unanimous. They determined to throw in their lot +with Great Britain and do everything that was possible to aid. This +determination found immediate expression in the decision of the +Government of Mr. Joseph Cook, endorsed later by the Government of Mr. +Fisher, to raise and equip a division of 18,000 men and send it to the +front as fast as possible. The system of compulsory military service +entails no obligation on the trainee to leave Australia, and in any +event, the system having been introduced so late as 1911, the trainees +were not available. The expedition consequently became a volunteer +expedition from the outset. Volunteers were rapidly forthcoming, camps +were established in the various States and training was actively begun. + +Of the difficulty and delays consequent on the raising of such a +force--of men mostly civilians, of all classes of society, without +clothing, or with insufficient clothing and equipment of all +kinds--little need be said. The difficulties were slowly overcome, and +the force gradually became somewhat efficient. As both officers and men +were learning their business together, the difficulties may well be +imagined. In fairness, however, it should be said that from the physical +and from the mental point of view the material was probably the finest +that could be obtained. + +We are, however, only concerned here with the medical aspect of the +movement. The medical establishment was modelled on that of Great +Britain, and consisted of regimental medical officers and of three field +ambulances. The Director-General accompanied the expedition as Director +of Medical Services, and Colonel Chas. Ryan, the Principal Medical +Officer of the State of Victoria, accompanied the expedition as A.D.M.S. +on the staff of General Bridges, the Commander of the Division. Colonel +Fetherston took General Williams's place as Acting Director-General of +Medical Services, and Colonel Cuscaden the place of Colonel Ryan as +Principal Medical Officer of the State of Victoria. + +The expedition left in October, a considerable delay having taken place +owing to the necessity of finding suitable convoy, a number of German +cruisers being still afloat and active. It reached Egypt without serious +mishap in December, and at once encamped near the Pyramids at Mena. + +There were some difficulties in transit. There was a most extensive +outbreak of ptomaine poisoning on one ship, and measles, bronchitis, and +pneumonia were much in evidence. The mortality was, however, small. The +division on arrival settled down to hard training. + +At once difficulties caused by the absence of Lines of Communication +Medical Units became obvious. The amount of sickness surprised those who +had not profited by previous experience. To meet the difficulty Mena +House Hotel was improvised as a hospital and staffed by regimental and +field ambulance officers. + +At this stage, however, we can leave the division and return to the +further development of medical necessities in Australia. + +[Illustration: MENA CAMP. +_To face page 6_]] + +Steps were at once taken in Australia to raise a second division, and +subsequently a third and other divisions in the same manner as the +preceding. As time passed on, the unsuitability of some of the camps and +the lack of medical military knowledge told their tale, and a number of +serious outbreaks of disease took place. It is impossible to give +accurate statistical evidence, but the Australian public seems to have +been shocked that young, healthy, and well-fed men should _in camp life_ +have been so seriously damaged and destroyed. The causes as usual were +measles, bronchitis, pneumonia, tonsillitis, and later on a serious +outbreak of infective cerebro-spinal meningitis which was stamped out +with difficulty and took toll (_inter alia_) in the shape of the lives +of three medical men. The sanitation of the Broadmeadows Camp near +Melbourne was not such as to provoke respect or admiration. The camp was +ultimately regarded as unsuitable, and moved to Seymour, pending the +necessary improvements. + +It is instructive to note in passing that the Australian public received +a shock when they were first informed of the amount of disease among the +troops in Egypt. Yet it was apparently nothing like so great as that +which existed in Australia, where the usual death-rate is so low. And +yet, had the Service really profited by the lessons of the +Russo-Japanese war, much of the trouble might have been avoided. The +truth of course is that camp life, except under rigorous discipline as +regards hygiene, and the loyal observance of that discipline by each +soldier, is much more dangerous than the great majority of people seem +to imagine. The benefit of the open-air life and of exercise is +counteracted by the chances of infection due to crowding, defective tent +ventilation, the absence of the toothbrush, and other causes. + +In September, however, the Imperial Government notified the Australian +Government that Lines of Communication Medical Units were required, and +for the first time the majority of members of the Australian Army +Medical Corps became aware of the nature of Lines of Communication +Medical Units. The Government decided to equip and staff a Casualty +Clearing Station, then called the Clearing Hospital, two Stationary +Hospitals (200 beds each), and two Base Hospitals (each 520 beds). They +were organised on the R.A.M.C. pattern, and the total staff required was +approximately eighty medical officers. Even at this juncture the matter +was not taken very seriously, and there was some doubt as to the nature +of the response. The Director of Medical Services was anxious that the +base hospitals should be commanded and staffed by men of weight and +experience, and accordingly a number of the senior medical consultants +in the Australian cities decided to volunteer. The example was +infectious and there were over-applications for the positions. + +The First Casualty Clearing Station was to a great extent raised and +equipped in Tasmania. The First Stationary Hospital was raised and +equipped in South Australia, the Second Stationary Hospital in Western +Australia, and the Second General Hospital in New South Wales. An +exception to this sound territorial arrangement was, however, made in +the case of the First Australian General Hospital--an exception +which proved unfortunate. The commanding officer, a senior +lieutenant-colonel, was resident in South Australia. The hospital +itself was recruited from Queensland, but as the Queensland medical +profession was hardly strong enough to supply the whole of the +medical personnel, most of the consultants, including all the +lieutenant-colonels, were recruited in Victoria. Now Brisbane, the +capital of Queensland, is some 1,200 miles by rail from Melbourne, and +Melbourne about 400 miles by rail from Adelaide, the capital of South +Australia. The result of these arrangements was that the captains and +some of the majors were recruited in Queensland, together with the bulk +of the rank and file and many of the nurses; whilst most of the senior +medical officers, the matron, and a number of nurses were recruited in +Melbourne, and the commanding officer (Lt.-Colonel Ramsay Smith) from +South Australia. He brought with him some seven or eight clerks and +orderlies. Furthermore a number of medical students and educated men +joined in Melbourne. The bulk of the staff was, however, based in +Queensland. This arrangement led to untold difficulties in the way of +recruiting, and it is remarkable that the result should have been as +satisfactory as it was. The equipment was provided partly from +Melbourne, partly from Brisbane, and partly from South Australia. As the +commanding officer was in South Australia, as the registrar and +secretary was in Melbourne, and as the orderly officer was in Brisbane, +some idea of the difficulties can well be imagined--particularly when it +is remembered that with the exception of the commanding officer and a +few officers, the members of the staff had no experience whatsoever of +military matters. Nevertheless an earnest effort was made to secure the +necessary equipment and personnel. In Melbourne great trouble was taken +to secure as many medical students and educated men as could possibly be +obtained. + +On the whole the response to the call was more than satisfactory, and +Australian people were of the opinion that a stronger staff could not +have been secured. + +It was at first intimated that specialists were not required, but +ultimately after discussion the Government agreed to find the salary of +one specialist. Consequently a radiographer was appointed with the rank +of Major, and another officer was appointed oculist to the hospital with +the rank of honorary Major. Subsequently he was appointed as secretary +and registrar in addition, but without salary or allowances. + +The equipment of the hospital was on the R.A.M.C. pattern, and was +supposed to be complete. Furthermore, the Australian branch of the +British Red Cross Society set aside for the use of the hospital one +hundred cubic tons of Red Cross goods which were specially prepared and +labelled at Government House, Melbourne. + + + + + CHAPTER II + + THE VOYAGE OF THE "KYARRA"--LACK OF ADEQUATE + PREPARATION--DIFFICULTIES OF ORGANISATION--PTOMAINE POISONING. + + + + + CHAPTER II + + +The mode of conveyance of the hospitals to the front next engaged the +attention of the authorities, and negotiations were entered into with +various steamship companies. It was desirable that the hospitals should +be conveyed under the protection of the regulations of the Geneva +Convention. + +After some negotiation and the rejection of larger and more suitable +steamers, a coastal steamer, the _Kyarra_, was selected and was fitted +to carry the hospital staff and equipment. The steamer is of about 7,000 +tons burden. There were on board approximately 83 medical officers, 180 +nurses, and about 500 rank and file, or a total of nearly 800 souls. The +cargo space was supposed to be ample, and 100 tons of space were +promised for the Red Cross stores. + +When ready, the _Kyarra_ proceeded to Brisbane and embarked a portion of +the First Australian General Hospital. She then proceeded to Sydney, +embarked the Second Australian General Hospital with its stores, +equipment, and Red Cross goods, and then left for Melbourne, where she +was to embark the remainder of the First Australian General Hospital, +the First Stationary Hospital, and the Casualty Clearing Station. + +On arrival at Melbourne, however, it was found that she was carrying +ordinary cargo, that she was not lighted as required by the rules of the +Convention, and that she was already fully loaded. Consequently the +whole of the cargo was taken out of her, the ordinary cargo was removed, +and she was reloaded. It was found, however, that there was no room for +the Red Cross goods belonging to the First Australian General Hospital. +Furthermore, a portion of the equipment which subsequently turned out to +be invaluable, namely 130 extra beds donated to the hospital by a firm +in Adelaide, was nearly left behind. It was only by the exercise of +personal pressure that space was found for this valuable addition at the +last minute. The importance of this donation will be mentioned later in +the story. + +Finally, after many delays, the _Kyarra_ left Melbourne on December 5 +amidst the goodwill and the blessings of the people, and made her way to +Fremantle, there to embark the Second Australian Stationary Hospital and +its equipment. She finally left Fremantle with this additional hospital, +and made her way across the Indian Ocean. + +Lieut.-Col. Martin, Commanding Officer of the No. 2 Australian General +Hospital, was promoted to the rank of Colonel for the voyage only. He +was promoted for the purpose of placing him in command of the troopship. + +The voyage of the _Kyarra_ involved calls at Colombo, Aden, Suez, Port +Said, and Alexandria. Those on board believed in the first instance they +were proceeding to France, and when they arrived at Alexandria, and +found they were all destined for Egypt, many expressed feelings of keen +disappointment on the ground that they would have no work to do. They +were soon, however, to be undeceived. + +[Illustration: THE S.S. "KYARRA." +_To face page 14_]] + +The voyage itself does not call for lengthy comment. The ship was +unsuitable for the purpose for which she had been chartered. She was +small, overcrowded, and not as clean or sanitary as she might have been. +Her speed seemed to decrease, and was scarcely respectable at any time; +there were apparently breakdowns of the engines; and the food supplied +to the officers and nurses was not infrequently inferior in quality and +in preparation. In consequence an outbreak of ptomaine poisoning took +place, and twenty-two officers and others were infected, two of them +seriously. + +The arrangements at the men's canteen had not been fully thought out, +and in the Tropics it was not possible to obtain fruit of any +description. Fresh or tinned fruits were not kept in stock. There was +some tinned meat and fish, but the men could obtain nothing to drink +except a mixture made from Colombo limes and water. + +There was a certain amount of illness apart from ptomaine poisoning, and +amongst the cases treated were bronchitis, influenza, tonsillitis, and +eye disease. Five cases reacted severely to anti-typhoid inoculation, +and required rest in hospital. + +On the whole, officers, nurses, and men took the voyage seriously, and +did their best to learn something of their work. The officers were +drilled, the nurses gave lessons to the orderlies, and systematic +lectures were given by the officers. An electric lantern had been +provided by the O.C., and lantern lectures were given regularly during +the voyage. + +The quarters provided in the fore part of the ship for the men were +certainly insanitary, and to an extent dangerous. Towards the end of the +voyage many cases of rotten potatoes were thrown overboard, having been +removed from beneath the quarters occupied by the men. With Red Cross +aid, however, provided by the Queensland branch, fans had been +installed, and an attempt made to render these quarters more sanitary +and habitable. A portion of the deck could not be used because of leaky +engines, and neither request nor remonstrance enabled those concerned to +get these leaks stopped. + +The following measurements show what trouble so simple a fault can +cause. In the tropics the wet portion of the deck could not of course be +used for sleeping purposes. + + APPROXIMATE DECK SPACE AVAILABLE FOR NO. 1 + GENERAL AND NO. 2 STATIONARY HOSPITALS + ON FORE DECK + + sq. ft. + + Approximate deck space available 1,920 + Space obtainable on hatches 288 + ----- + 2,208 + + Space permanently wet through leaking + engines 648 + ----- + Approximate net 1,560 + +As the number of men occupying these quarters (including sergeants and +warrant officers) was about 300, the space available approximated 5 sq. +ft. per man. + +Notwithstanding these conditions, the usual peculiarity of Anglo-Saxon +human nature showed itself when at the end of the voyage the officers +were required to sign the necessary certificates stating that the +catering had been satisfactory. Only three refused to sign; the +remainder signed, mostly with qualifications. + +The manner in which the average Australian makes light of his +misfortunes was strikingly illustrated on one occasion. A long, mournful +procession of privates slowly walked around the deck. In front, with +bowed head, was a soldier in clerical garb, an open book in his hand. +Immediately behind him were four solemn pall-bearers, carrying the day's +meat ration, which is stated to have been "very dead." Apparently the +entire ship's company acted as mourners. The procession wended its way +to the stern, where an appropriate burial service was read; the ship's +bugler sounded the "last post," and the remains were committed to the +deep. Needless to say the usual formality of stopping the ship during +the burial service was not observed on this occasion. An attempt to +repeat the performance was fortunately stopped by those in authority, +and all subsequent "burials" were strictly unceremonious. + +Those who go to war must expect to rough it, but on a peaceful ocean, +secure from the enemy, and in a modern passenger ship, it should be +possible to provide food which does not imperil those who consume it, +and also to ensure reasonable comfort. + +With reference to the defects of the ship it should be said that when +the _Kyarra_ was chartered Australians had not realised the colossal +nature of the war, and had not begun to think on a large scale, and +those responsible had neither tradition nor experience to guide them. +Furthermore the commander and officers of the _Kyarra_ courteously did +their best, but it was evident they understood the difficulty of +transforming a coastal steamer into a Hospital Transport. + +The Geneva Convention does not seem to be fully understood, and +experience shows what complicated conditions arise, and how easy it is +to commit an unintentional breach of the Regulations. But in war there +can be no excuses. + + + + + CHAPTER III + + ARRIVAL AND SETTLEMENT IN EGYPT--DISPOSAL OF THE HOSPITAL + UNITS--TREATMENT OF CAMP CASES--THE ACQUISITION OF MANY + BUILDINGS--WHERE THE THANKS OF AUSTRALIA ARE DUE. + + + + + CHAPTER III + + +On arrival at Alexandria, there seemed to be no great hurry in +disembarking, and many of the older medical officers were fully +persuaded that the units were not wanted in France; that there was very +little to do in Egypt; and that if their services were not required it +would be fairer to inform them of the fact, and let them go home again. +They were soon to be undeceived. A message was received asking the O.C.s +of the various units to visit Cairo, where they waited on +Surgeon-General Ford, Director of Medical Services to the Force in +Egypt. They were informed that there was more than enough work for all +these Lines of Communication Medical Units in Egypt. + +The First Australian General Hospital was to be placed in the Heliopolis +Palace Hotel at Heliopolis. The Second Australian General Hospital was +to take over Mena House and release the regimental medical officers and +officers of the Field Ambulances from the hospital work they were doing. +The First Stationary Hospital was to be placed with the military camp at +Maadi, and the Second Australian Stationary Hospital was to go into camp +at Mena and undertake the treatment of cases of venereal diseases. The +First Casualty Station was temporarily lodged in Heliopolis, and then +sent to Port Said to form a small hospital there in view of the +imminent fighting on the Canal. These dispositions were made as soon as +possible. + +It should be noted at this juncture that the bulk of the Australian +Forces, namely the First Division, was camped at Mena. A certain +quantity of Light Horse was encamped at Maadi, whilst the Second +Division, composed chiefly of New Zealanders, was encamped near +Heliopolis. New Zealand had not provided any Lines of Communication +Units, but her sick had been accommodated at the British Military +Hospital, Citadel, Cairo, and also at the Egyptian Army Hospital, +Abbassia. + +The First and Second Stationary Hospitals used their tents for the +respective purposes. The Casualty Clearing Station utilised a building +assigned to it in Port Said. + +Some description is required, however, of the Heliopolis Palace Hotel. +This, as the photograph shows, is a huge hotel de luxe, consisting of a +basement and four stories. + +It was arranged that the kitchens, stores, and accommodation for rank +and file should be placed in the basement. The first floor was allotted +to offices and officers' quarters; a wing of the third floor provided +accommodation for nurses, and the only portions of the building used at +first for patients were the large restaurant and dining-room, and the +billiard recesses, _i.e._ the Rotundas and Great Hall. + +The hospital when fully developed required a large staff. The two large +wards in the Rotundas and Central Hall could be administered easily +enough, but the rest of the hotel consisted of rooms holding from three +to six beds. The doors were removed. There were fortunately many +bathrooms and lavatories. The rooms are very lofty, and provided with +very large windows, but there are no fanlights over the doors, so that +if doors were left in place ventilation was inadequate. A good deal of +difficulty was experienced in providing suitable slop hoppers and sinks, +places for cleaning bed-pans and the like, but little by little suitable +arrangements were made. + +[Illustration: HELIOPOLIS PALACE HOTEL, SHOWING INFECTIOUS DISEASES CAMP. +_To face page 22_]] + +[Illustration: PLAN OF HELIOPOLIS PALACE HOTEL. +_To face page 23_]] + +The Arab servants, employed to ease the pressure on the staff, were +housed in tents in one part of the grounds, and some of the rank and +file in tents in another part. Others, for a short period, slept on the +roof. The accommodation in general of the rank and file was excellent. +The kitchens were a source of difficulty as the ranges were so +elaborate; the hot-water service was unsatisfactory because of failure +of fuel due to war conditions. Still, by one device and another, smooth +running was ultimately secured. + +When full value is given to all adverse criticism, it must be admitted +that few better surgical hospitals could have been obtained. + +The Officer Commanding the hospital (Lt.-Colonel Ramsay Smith) visited +it with the Registrar, and made the preliminary arrangements. He then +returned to Alexandria to supervise the disembarkation. Meanwhile the +Registrar spent his time interviewing the proprietors, the D.M.S., and +others concerned. + +Only those who, knowing nothing of military organisation, tackle a job +of the kind can fully appreciate the bewilderment caused by the mystic +letters A.D. of S. and T., D.A.A. and Q.M.G., and the like, with all +they connote. The Imperial officers saw the difficulties and were +kindly and helpful to a remarkable degree. + +The hospital was opened on January 25, with provision for 200 patients. +The first patient to be admitted was suffering from eye disease. An +ophthalmic department was opened on the first floor, providing +accommodation for out-patients as well as in-patients. As there were few +oculists and aurists in Egypt at this juncture other than those at this +hospital, the department rapidly assumed formidable proportions. The +solid floors, lofty rooms, shuttered windows, and provision of electric +light lent themselves to the creation of an excellent ophthalmic +department. + +The number of soldiers within easy distance of Heliopolis was not very +great. Nevertheless patients, mostly medical cases, made their +appearance in steadily increasing numbers, especially as Mena House was +soon filled, and was limited in its accommodation. + +With the arrival of the Second Australian Division in Egypt, and of +subsequent reinforcements, the pressure on the First Australian General +Hospital intensified, since these new arrivals went into camp at or near +Heliopolis. The hotel rooms were filled with valuable furniture, +including large carpets. From the outset it was arranged that neither +carpets nor curtains were to be retained, and that the only hotel +furniture which was to be used was beds and bedding for the officers and +nurses. Everything else was stored away in various rooms. Up to this +period the belief in official circles was that the First Australian +General Hospital would soon be moved to France, and that it was +consequently unwise to expand further, or to spend any considerable sum +of money. The pressure, however, steadily continued, and when the +Dardanelles campaign commenced, orders were given for the immediate +expansion of the hospital to meet the ever-growing requirements of the +troops. In order to effect this development the whole of the hotel +furniture was moved into corridors of the building. Subsequently it was +taken from the building and stored elsewhere, a difficult proceeding +involving a great deal of labour. + +[Illustration: THE MAIN HALL, HELIOPOLIS PALACE HOTEL. +_To face page 24_]] + +[Illustration: SURGICAL WARD, HELIOPOLIS PALACE HOTEL. +_To face page 25_]] + + +VENEREAL AND INFECTIOUS DISEASES CAMP + +On February 7 a New Zealand Field Ambulance which had taken charge of +the venereal cases in camp, nearly 250 in number, was summarily ordered +to the Suez Canal. Orders were given on that evening at 9 p.m. that the +tent equipment of the First Australian General Hospital was to be +erected at the Aerodrome Camp (about three-quarters of a mile distant), +and that the hospital was to staff and equip a Venereal Diseases Camp by +2 p.m. the following day. By this time, too, large numbers of cases of +measles had made their appearance, and it was quite clear that some +provision must be made for these and other infectious cases. Accordingly +another camp was pitched alongside the Venereal Camp for the +accommodation of those suffering from infectious diseases. By direction +of the D.M.S. Egypt, a senior surgeon was appointed to command the camp, +and was given the services of two medical officers, one in connection +with the venereal cases, and one in connection with the infectious +cases. Definite orders were given that such cases were not to be +admitted into the General Hospital. + +The camp was no sooner pitched than it was filled, and the demand on the +accommodation for venereal and other cases rose until upwards of 400 +venereal cases, and 100 infectious cases--chiefly measles--were provided +for. A good deal of difficulty was experienced in suitably providing for +the serious measles cases in camp, and accordingly a limited number of +tents were erected in the hospital grounds, and a small camp was formed +in that position, and placed under the charge of a nursing sister. To +this camp all serious cases of infectious disease, and all cases with +complications, were immediately transferred. It may be said in passing +that the cases treated in this way did exceedingly well. + +The number of venereal cases would have wholly out-stepped the +accommodation had it not been for the policy adopted by the D.M.S. +Egypt. All venereal cases not likely to recover rapidly were sent back +to Australia, or (on one occasion) to Malta. + + +ACQUISITION OF MANY BUILDINGS + +The hospital, then, at this juncture consisted of the main building, in +which the accommodation was being steadily extended by the utilisation +of all the rooms, and of the venereal and infectious diseases camp. + +[Illustration: HELIOPOLIS PALACE HOTEL: ISOLATION TENTS. +_To face page 26_]] + +[Illustration: THE RINK, LUNA PARK, HELIOPOLIS. +_To face page 27_]] + +The first khamsin, however, which blew warned every one concerned that +patients could not be treated satisfactorily in tents in midsummer. At +the request of the medical officer in charge, two rooms in one wing of +the main building were given over to bad infectious cases, and the camp +in the grounds was abolished. The arrangement was unsatisfactory. The +cases did not do as well as might have been desired, though this was +attributed to an alteration in their type; and renewed efforts were made +to devise a better arrangement. Finally a portion of the Abbassia +barracks was obtained, and converted into an excellent venereal diseases +hospital to which the venereal cases were transferred. + +The Mena camp had been struck, and the troops sent to the Dardanelles; +the First and Second Stationary hospitals had moved to Mudros; and the +First Casualty Clearing Station had been transferred to the Dardanelles. +Consequently the pressure fell almost entirely on the First General +Hospital, and the Venereal Diseases Hospital thus became the only +Venereal Diseases Hospital in Egypt. + +Close to the Palace Hotel there was a large pleasure resort, known as +the Luna Park, at one end of which was a large wooden skating-rink, +enclosed by a balcony on four sides. This building was obtained, and was +railed off from the rest of Luna Park by a fence 13 feet high. The +infectious cases from the camp were then transferred to it. A camp +kitchen was built, and an admirable open-air infectious diseases +hospital was obtained. It became obvious, however, that the +skating-rink, which with the balcony could accommodate, if necessary, +750 patients, might better serve as an overflow hospital in case of +emergency, and accordingly efforts were made to obtain another +infectious diseases hospital in the vicinity. + +Eventually a fine building known as the Race Course Casino, a few +hundred yards from the Heliopolis Palace, was obtained and converted +into an infectious diseases hospital providing for the accommodation of +about 200 patients. With its ample piazzas and excellent ventilation it +formed an ideal hospital, and was reluctantly abandoned at a later date +owing to the development of structural defects which threatened its +stability. + +The position, then, at this stage was that the First Australian General +Hospital consisted of (1) the Palace Hotel, ever increasing in its +accommodation as the furniture was steadily removed and space +economised, its magnificent piazzas utilised, and tents erected in the +grounds for the accommodation of the staff; of (2) the rink at Luna +Park, which was now empty and ready for the reception of light cases +overflowing from the Palace; of (3) the Casino next door to Luna Park, +which had now become an infectious diseases hospital; and of (4) the +Venereal Diseases Hospital at Abbassia, which soon became an independent +command though still staffed from No. 1 General Hospital. + +[Illustration: THE CASINO, HELIOPOLIS: INFECTIOUS DISEASES HOSPITAL. +_To face page 29_]] + + +PREPARATION IN ANTICIPATION + +At or shortly before this period, however, the authorities had become +aware that wounded might be received from the Dardanelles at some future +date in considerable numbers, which could not, however, be accurately +estimated. Accordingly a consultation was held between Surgeon-General +Ford and Surgeon-General Williams (who arrived in Egypt in February), +Colonel Sellheim, who was the officer commanding the newly formed +Australian Intermediate Base, the O.C. of the First Australian General +Hospital, Lieut.-Col. Ramsay Smith, and Lieut.-Col. Barrett. It was +decided to authorise the expenditure of a considerable sum of money in +making the necessary preparation, on the ground that if the wounded did +not arrive the Australian Government would justify this action, and that +if the wounded did arrive a reasonable attempt would have been made to +meet the difficulty. Instructions were accordingly given to buy up beds, +bedding, and equipment, which would _inter alia_ provide at least +another 150 beds in the Infectious Diseases Hospital and 750 in the +rink. At first iron beds were purchased, but it was impossible to obtain +deliveries of iron beds at a rate exceeding 120 a week, and there were +(practically) none ready made in Egypt. It was during this period of +expansion that the donation of 130 beds made to Lieut.-Col. Ramsay Smith +in Adelaide proved to be so useful. + +It was, therefore, quite certain that full provision could not be made +in time if iron beds were to be used, and accordingly large purchases of +palm beds were made. These are very strong, stoutly constructed beds, +made of palm wood. They are quite comfortable and last for several +months. The drawback is that they are liable ultimately to become +vermin-infected and that their sharp projecting struts are very apt to +catch the dresses of those who pass by. We were able, however, to obtain +them with mattresses at a rate exceeding 100 a day. They were ordered +in practically unlimited numbers, so that shortly there was +accommodation for the 900 patients referred to. In addition a large +reserve of beds and mattresses had been created so that they could be +placed in the corridors if it became necessary. + +At an earlier date the project of taking the whole of Luna Park and +using the upper portion of it, the Pavilion, as well as the lower +portion, the Rink, had been under contemplation, but had been rejected +on the ground of expense. The rental demanded was high, owing to the +fact that the park must perforce be closed as a pleasure resort if used +as a hospital. + +The conveyance of sick and wounded from Cairo to Heliopolis next engaged +attention, and on April 26 it was found possible to run trains from +Cairo on the tram-lines to Heliopolis Palace Hotel. A trial run was made +about midnight on the 27th. The first train containing sick from Mudros +arrived on the evening of the 28th, and on the 29th and 30th without +warning the wounded poured into Heliopolis. + +As soon as the nature of the engagement at the Dardanelles became known, +the D.M.S. Egypt ordered that the whole of Luna Park be taken over and +immediately equipped. The pavilion was made ready for the reception of +the wounded within a very few hours, and in a few days Luna Park was so +equipped with baths, latrines, beds, bedding, etc., that it could +accommodate 1,650 patients. + +[Illustration: THE PAVILION, LUNA PARK, HELIOPOLIS. +_To face page 30_]] + +Never before in history were precautions better justified. Had the +expenditure not been incurred, had the representative of the Australian +Government held up the execution of the policy of preparation by waiting +for instructions, a disaster would have occurred, and many wounded would +have been treated in tents in the sand of the desert. Yet so strangely +constituted is a minor section of humanity that instead of satisfaction +being expressed that the best possible had been done, some criticism was +levelled at the undertaking on the ground that it was not at the outset +technically perfect, and that it showed the initial defects inseparable +from rapid improvisation. The Australian people should be profoundly +grateful to Surgeon-General Williams and Colonel Sellheim, whose +decisive promptitude enabled the position to be saved. + + + + + CHAPTER IV + + THE RUSH OF WOUNDED AND RAPID EXPANSION OF HOSPITALS--SAVING THE + SITUATION--PERIOD OF IMPROVISATION--SHORTAGE OF STAFF AND + EQUIPMENT--HOW THE EXPANSION WAS EFFECTED--THE NUMBER OF SICK + AND WOUNDED. + + + + + CHAPTER IV + + +During the first ten days of the crisis approximately 16,000 wounded men +entered Egypt, of whom the greater number were sent to Cairo, and during +those ten days an acute competition ensued between the supply of beds +and the influx of patients. Fortunately the supply kept ahead of the +demand, the pressure being eased by the immediate provision at Al Hayat, +Helouan, of a convalescent hospital capable of accommodating 1,000 and +in an emergency even 1,500 patients. + +At the end of the ten days referred to, the position was as follows: + +Heliopolis Palace Hotel had expanded to 1,000 beds, Luna Park +accommodated 1,650 patients, the Casino would accommodate 250, the +Convalescent Hospital, Al Hayat, Helouan, was accommodating 700, and if +need be could accommodate 1,500 patients, and the Venereal Diseases +Hospital could receive 500 patients. + +In the meantime No. 2 General Hospital had been transferred to Ghezira +Palace Hotel, which was rapidly equipped, and at a later date became +capable of receiving as many as 900 patients. Mena House remained an +overflow hospital, bearing the same relation to No. 2 General Hospital +as the Auxiliary Hospitals at Heliopolis bore to No. 1 General +Hospital. + +It was quite evident, however, that the accommodation was still +insufficient, and a further search was made for other buildings. At this +juncture a building opposite Luna Park known as the Atelier was offered +by a Belgian firm for the use of the sick and wounded. It consisted of a +very large brick building, with a stone floor and a lofty roof, which +had been used as a joinery factory. At first the idea was entertained of +creating a purely medical hospital, and of keeping the Heliopolis Palace +for heavy surgery, with the auxiliaries for lighter cases. This policy +was found to be impracticable, and the Atelier was converted into a +400-bed auxiliary hospital similar in character to Luna Park. + +It was open for the reception of patients on June 10, and on the 11th +was practically full of wounded. + +As it was evident that the accommodation was still insufficient, a +further search was made, and the Sporting Club pavilion, a building in +the vicinity of the Heliopolis Palace, was taken over, and converted +into a hospital of 250 beds. It was at first intended to use it as an +infectious diseases hospital. As, however, it possessed great +possibilities of expansion if suitable hutting could be erected, another +infectious diseases hospital was sought elsewhere, and wooden shelters +were erected. The accommodation of the Sporting Club was raised by this +means to 1,250 beds. + +[Illustration: THE ATELIER, HELIOPOLIS. +_To face page 37_]] + +The heat of summer was coming on, and the necessity for providing +seaside accommodation for the convalescents from Cairo became obvious. +Consequently the Ras el Tin school at Alexandria was taken by No. 1 +General Hospital, and turned into an excellent convalescent hospital for +500 patients. It consisted of a very large courtyard, surrounded by +(mostly) one-story buildings, and was about 400 yards from the sea. In +the courtyard a Recreation Tent, provided by the British Red Cross +Australian Branch, was erected by the Y.M.C.A. The whole formed an +admirable seaside convalescent hospital. + +But even now the accommodation was not sufficient, and by direction the +Grand Hotel, Helouan, was acquired, and converted into an additional +convalescent hospital for 500 patients. This institution, however, was +shortly afterwards transferred to the Imperial authorities and used for +British troops. + +The structural defects in the Casino or Infectious Diseases Hospital, +and the undesirability of using the Sporting Club for this purpose, +necessitated the erection of an Infectious Diseases Hospital elsewhere. +A beautifully constructed private hospital, the Austrian Hospital at +Choubra, was commandeered and staffed by the First Australian General +Hospital, and provided 250 beds. This hospital also was, however, soon +transferred to the Imperial authorities, and administered as a British +hospital. + +As the demand for accommodation for infectious cases increased, the +artillery barracks at Abbassia were taken over by the Australian +authorities, and converted into an Infectious Diseases Hospital which +ultimately accommodated 1,250 patients. + +The needs continuing to press, the Montazah Palace at Alexandria was +offered by His Highness the Sultan to Lady Graham as a convalescent +hospital. The offer was gratefully accepted by the combined British and +Australian Branches of the Red Cross Society. It is the only hospital +in Egypt in the administration of which the Australian Red Cross takes +part. + +In addition to these major activities, there were many other minor +changes. The introduction of cholera from Gallipoli was feared, and in +the grounds of the Casino a cholera hospital was erected in anticipated +need, under the direction of the Board of Public Health, Egypt. +Fortunately it was never required, but it was ready for use, and would +have been staffed by the First Australian General Hospital. + +The final result, then, of all these expansions was as follows. The +520-bed hospital which landed in Egypt on January 25 had expanded into: + + Beds + + Heliopolis Palace Hotel 1,000 + Luna Park 1,650 + Atelier 450 + Sporting Club 1,250 + Choubra Infectious 250 + Abbassia Infectious 1,250 + Venereal Diseases, Abbassia 2,000 + Al Hayat, Helouan (Convalescent) 1,250 + Ras el Tin (Convalescent) 500 + Montazah Palace (Convalescent, Australian moiety) 500 + Grand Hotel, Helouan 500 + ------ + (Approximately) 10,600 + ====== + +Almost the whole of this work was undertaken by the staff originally +intended to manage a 520-bed hospital, at all events until the latest +developments. Reinforcements did not arrive until June 15, and even then +they were not long available. + +To house the reinforcements of nurses two other buildings were taken at +Heliopolis: Gordon House, opposite Luna Park, and the Palace of Prince +Ibrahim Khalim, on the outskirts of Heliopolis. + +It will be noted that the greater part of the expansion took place in +the immediate vicinity of the Palace Hotel. This step was alike +deliberate and necessary, for reasons that will be explained hereafter. + + +METHODS ADOPTED IN ORGANISING HOSPITALS + +The methods adopted in organising these hospitals varied. In the first +instance Lieut.-Col. Barrett was deputed by the D.M.S. Egypt to seek for +the necessary buildings, and when these were approved to negotiate with +the owners respecting the rent. This proceeding proved very tedious and +difficult, and in pursuance of a General Army Order another and simpler +plan was adopted by the appointment of an arbitration commission under +the chairmanship of Sir Alexander Baird. To this commission the +determination of rent and compensation was referred when the acquisition +of the buildings received the sanction of the Commander-in-Chief. It +need hardly be said that a good deal of tact was necessary in these +proceedings, and every attempt was made to meet the wishes of owners +with regard to the buildings commandeered. + +Up till June 15 the number of nurses available was small, and it became +quite obvious that, owing to the rush of sick and wounded, and the hot +weather, some of the nurses would experience a breakdown. Lieut.-Col. +Barrett accordingly visited Alexandria, and arranged with the Australian +and Egyptian branches of the British Red Cross Society to take over and +equip two buildings as Rest Homes. These houses had been generously +offered for this purpose to Her Excellency Lady MacMahon, wife of the +High Commissioner for Egypt. One of these buildings was a large house +belonging to a distinguished Egyptian and was situated in Ramleh, not +very far from the beach, and the other was about eight miles from +Alexandria at Aboukir Bay, the site of Nelson's victory. The latter +consisted of a large seaside bungalow owned by Mr. Alderson, with an +excellently fitted house-boat anchored some little distance from the +shore. + +The Australian Government undertook to pay for the maintenance of the +nurses in these homes, which were placed under the management of a joint +committee of the two branches of the Red Cross Society, under the +presidency of Lady MacMahon. Nurses were then sent to these homes for a +week at a time, and derived great benefit from the sea-bathing. These +vacations formed a welcome and healthy break in work of excessive +severity. + +The following table indicates the dates of the principal changes which +took place in the First Australian General Hospital. + + CHRONOLOGY OF THE FIRST AUSTRALIAN GENERAL HOSPITAL + + January 14.--Arrived at Alexandria. + January 24.--Arrived at Heliopolis. + February 7.--Established Aerodrome Camp. + April 6.--Luna Park taken over. + April 19.--Established Venereal Hospital, Abbassia. + April 26.--The Casino taken over. + April 29.--Arrival of wounded. + May 1.--Prince Ibrahim Khalim's Palace taken over. + May 5.--Al Hayat Hotel taken over. + May 26.--The Atelier taken over. + May 27.--Gordon House taken over. + June 10.--Sporting Club taken over. + +[Illustration: THE SPORTING CLUB, HELIOPOLIS. +_To face page 40_]] + + +THE POLICY OF EXPANSION + +It has frequently been said in criticism of the Auxiliary Hospitals that +it would have been better to have taken over Shepheard's Hotel, or the +Savoy. Neither Shepheard's nor the Savoy (particularly the former) is +very suitable for hospital purposes, since hotels containing a large +number of small rooms involve much labour, and consequently a large +staff, and the authorities were faced with the fact that there was no +staff available. Surgeon-General Williams had cabled to Australia for +reinforcements long before the crisis, but the reinforcements did not +arrive until the middle of June. Clearly the sound policy was to obtain +buildings as close to Heliopolis as possible, to administer them with a +small staff, and to use them as overflow hospitals. Shepheard's or the +Savoy would have required a very large staff, and it was not existent. +Even at Helouan the employment of civilians as officers was necessary in +order to carry on. Arab servants were extensively employed by reason of +the shortage of staff. They acted as menservants, sweepers, and the +like. + + +MOTOR AMBULANCES + +When the _Kyarra_ arrived in Egypt the British authorities did not +possess any motor transport. There were some motor ambulances belonging +to the New Zealand authorities and a few motor ambulances which +accompanied the hospitals on the _Kyarra_, and which had been allotted +to special units. It became obvious, however, that units might be placed +in circumstances in which they did not require their ambulances, and +others in circumstances in which they required more than their share; +and accordingly Surgeon-General Williams decided to park the whole of +these motor ambulances in two garages, a major one at Heliopolis and a +smaller one at Ghezira, near No. 2 General Hospital. The garage at +Heliopolis held at least thirty motor ambulances. It belonged to the +Heliopolis Palace Hotel, and was equipped and furnished with a repairing +plant at the expense of the Australian branch of the British Red Cross. +The Ghezira garage was dealt with in like manner, and in addition the +rent was paid in the first instance by the Australian branch of the +British Red Cross. The organisation of these garages involved +considerable difficulty. The drivers employed were not recruited by the +Commonwealth Government as belonging to the motor transport, since there +was not any motor ambulance establishment, and they consequently only +received the ordinary private's pay. Furthermore promotions were very +difficult to effect. Nevertheless they saved the position. For a long +while Egypt was absolutely dependent on these motor fleets for the +removal of the sick and wounded, British or Australian. The work was +excessive but the drivers responded splendidly. Difficulties arose +through different units endeavouring to commandeer motor ambulances for +their own use. This was met by a decision of the D.M.S. Egypt that +ambulances were to be kept in the garages, and telephoned for when +necessary. From the outset, the lack of runabout motors was severely +felt, and ambulances were frequently employed for purposes which would +have been better effected by runabouts. + +[Illustration: THE FLEET OF AMBULANCES, HELIOPOLIS. +_To face page 42_]] + + +THE ARRIVAL OF THE SICK AND WOUNDED FROM THE FRONT + +The end of April was reached. The bulk of the forces had disappeared +from Egypt, and their position was only known by rumour; the hospital +was gradually emptied of patients; Mena Camp had been abandoned, and +Maadi Camp was reduced to small proportions. The weather was beautiful, +and any one might have been easily lulled into a sense of false +security. On April 28, however, a train-load of sick arrived. Its +contents were not known until it arrived at the Heliopolis siding. The +patients had come from Mudros, and numbered over 200 sick, including +some 60 venereal cases, a matter of some interest in the light of +subsequent events. + +On the following day, however, without notice or warning of any +description, wounded began to arrive in appalling numbers. On April 30 +and May 1 and 2 no less than 1,352 cases were admitted at Heliopolis. + +The expansion already indicated at Luna Park was at once effected, and +some relief was obtained by transferring the lighter cases to Mena +House--some seventeen miles distant. The last train-load of wounded +arrived in the early morning of May 2, and deserves special notice, as +many of the men were very seriously injured. There were about 100 cases; +the train arrived at midnight, and was emptied by 4 o'clock in the +morning. The bearing of the men badly injured was past praise. At 4 +a.m. the main operating-room of the hospital bore eloquent testimony to +the gravity of the work, which had been going on for many hours, and the +exhausted condition of the staff further demonstrated what had occurred. +The staff at the hospital was quite inadequate to cope with the rush, +notwithstanding the willingness of every one concerned, and accordingly +volunteers from some of the Field Ambulances, and from the Light Horse +units which were still in Egypt, were called for and readily obtained. +With the aid of the volunteers and by dint of universal devotion to duty +the work was done, and on the whole done well. + +The following table shows the staff available from April 2 to August 18, +and the work required of it: + + STAFF, ETC., OF NO. 1 GENERAL HOSPITAL AT HELIOPOLIS, INCLUDING + AUXILIARY HOSPITALS + + --------+---------+--------+---------+----------+------- + Date. |Officers.| Nurses.| Rank and| Patients.| No. of + | | | File. | | Beds. + --------+---------+--------+---------+----------+------- + April 25| 28 | 92 | 163 | 495 | 893 + 26| 29 | 92 | 187 | 504 | 893 + 27| 28 | 92 | 184 | 479 | 897 + 28| 28 | 92 | 184 | 479 | 895 + 29| 28 | 92 | 197 | 631 | 925 + 30| 28 | 92 | 204 | 1,082 | 1,100[1] + May 1| 26 | 92 | 216 | 1,324 | 1,100 + 2| 26 | 92 | 236 | 1,465 | + 3| 32 | 92 | 236 | 1,425 | + 4| 28 | 109 | 221 | 1,427 | + 5| 30 | 107 | 221 | 1,389 | + 6| 30 | 107 | 209 | 1,362 | 2,108 + 7| 30 | 107 | 198 | 1,353 | + 8| 30 | 107 | 198 | 1,454 | + 9| 29 | 107 | 201 | 1,432 | + 10| 26 | 107 | 201 | 1,485 | + 11| 26 | 107 | 209 | 1,618 | 2,493 + +[Illustration: THE OPERATING ROOM, HELIOPOLIS PALACE HOTEL. +_To face page 44_]] + + --------+---------+--------+---------+----------+------- + Date. |Officers.| Nurses.| Rank and| Patients.| No. of + | | | File. | | Beds. + --------+---------+--------+---------+----------+------- + May 12| 26 | 107 | 209 | 1,846 | 2,487 + 13| 28 | 107 | 249 | 2,293 | 2,592 + 14| 29 | 107 | 244 | 2,302 | 2,726 + 15| 29 | 107 | 244 | 2,218 | 2,705 + 16| 32 | 107 | 261 | 2,208 | 2,679 + 17| 30 | 107 | 259 | 2,165 | 2,646 + 18| 30 | 107 | 252 | 2,187 | 2,940 + 19| 30 | 107 | 274 | 1,911 | + 20| 30 | 107 | 302 | 1,904 | + 21| 29 | 107 | 290 | 1,889 | + 22| 29 | 107 | 287 | 1,856 | + 23| 29 | 107 | 287 | 1,812 | + 24| 29 | 104 | 287 | 1,811 | + 25| 32 | 104 | 299 | 1,777 | + 26| 32 | 104 | 295 | 1,768 | + 27| 32 | 104 | 295 | 1,805 | + 28| 32 | 104 | 317 | 1,781 | + 29| 35 | 143 | 319 | 1,931 | + 30| 35 | 143 | 322 | 1,918 | + 31| 35 | 143 | 322 | 1,820 | + June 1| 35 | 143 | 322 | 1,876 | + 2| 35 | 143 | 315 | 1,873 | + 3| 36 | 143 | 314 | 1,869 | + 4| 36 | 147 | 277 | 1,866 | + 5| 35 | 147 | 277 | 1,872 | + 6| 36 | 147 | 264 | 1,786 | + 7| 36 | 147 | 264 | 1,627 | + 8| 34 | 147 | 253 | 1,709 | + 9| 34 | 147 | 253 | 2,474 | 2,805 + 10| 32 | 133 | 247 | 2,211 | + 11| 32 | 133 | 247 | 2,605 | + 12| 32 | 133 | 262 | 2,375 | + 13| 32 | 133 | 263 | 2,384 | + 14| 34 | 133 | 264 | 2,324 | + 15| 34 | 133 | 264 | 2,324 | + 16| 54[2] | 171[3]| 463[4]| 2,269 | + 17| 54 | 171 | 463 | 2,328 | + 18| 55 | 165 | 462 | 2,259 | + 19| 55 | 165 | 449 | 2,266 | + 20| 55 | 165 | 443 | 2,339 | + 21| 55 | 165 | 439 | 2,335 | + 22| 55 | 165 | 439 | 2,357 | + + --------+---------+--------+---------+----------+------- + Date. |Officers.| Nurses.| Rank and| Patients.| No. of + | | | File. | | Beds. + --------+---------+--------+---------+----------+------- + June 23| 55 | 165 | 439 | 2,159 | + 24| 55 | 165 | 438 | 2,157 | + 25| 55 | 163 | 438 | 2,003 | + 26| 55 | 163 | 429 | 1,926 | + 27| 55 | 163 | 429 | 1,887 | + 28| 55 | 163 | 429 | 2,121 | + 29| 54 | 163 | 429 | 2,150 | + 30| 55 | 163 | 429 | 2,135 | + July 1| 55 | 163 | 430 | 2,332 | 2,956 + 2| 58 | 163 | 430 | 2,305 | + 3| 58 | 163 | 405 | 2,187 | + 4| 55 | 163 | 403 | 2,131 | + 5| 55 | 163 | 395 | 2,131 | + 6| 55 | 157 | 325 | 2,032 | + 7| 55 | 157 | 395 | 1,982 | + 8| 56 | 157 | 395 | 2,107 | + 9| 55 | 157 | 397 | 2,120 | + 10| 56 | 157 | 393 | 2,145 | + 11| 56 | 157 | 399 | 2,115 | + 12| 52 | 157 | 399 | 2,072 | + 13| 52 | 155 | 394 | 2,130 | + 14| 52 | 155 | 394 | 2,087 | + 15| 52 | 155 | 391 | 2,101 | + 16| 52 | 153 | 407 | 1,930 | + 17| 51 | 155 | 410 | 1,885 | + 18| 51 | 153 | 561 | 1,785 | + 19| 73 | 234 | 616 | 1,713 | + 20| 73 | 234 | 616 | 1,782 | + 21| 79 | 231 | 565 | 1,716 | + 22| 79 | 231 | 374 | 1,487 | + 23| 78 | 223 | 570 | 1,450 | + 24| 75 | 226 | 568 | 1,476 | + 25| 75 | 226 | 548 | 1,438 | + 26| 75 | 226 | 548 | 1,447 | + 27| 74 | 226 | 555 | 1,434 | + 28| 74 | 226 | 555 | 1,692 | + 29| 75 | 226 | 544 | 1,695 | + 30| 75 | 224 | 449 | 1,452 | + 31| 70 | 224 | 457 | 1,362 | + Aug. 1| 70 | 224 | 457 | 1,588 | 2,876 + 2| 70 | 224 | 457 | 1,610 | + 3| 71 | 224 | 447 | 1,652 | + 4| 71 | 224 | 447 | 1,631 | + 5| 61 | 224 | 447 | 1,759 | + 6| 60 | 224 | 456 | 1,731 | + +UNLOADING THE HOSPITAL TRAIN, HELIOPOLIS SIDING. +_To face page 47_] + + --------+---------+--------+---------+----------+-------- + Date. |Officers.| Nurses.| Rank and| Patients.| No. of + | | | File. | | Beds. + --------+---------+--------+---------+----------+-------- + Aug. 7| 60 | 224 | 456 | 1,793 | + 8| 60 | 224 | 424 | 1,927 | + 9| 59 | 224 | 432 | 1,902 | + 10| 58 | 224 | 432 | 339[5]| + 11| | | | 357 | + 12| | | | 542 | + 13| 42 | 216 | 416 | 454 | + 14| 47 | 216 | 462 | 504 | + 15| 45 | 216 | 462 | 535 | + 16| 45 | 216 | 480 | 587 | + 17| 47 | 216 | 484 | 485 | + 18| 48 | 216 | 460 | 470 | + +The proceeding adopted on arrival of the train was as follows: Two +officers were on duty on the platform in control of guard and stretcher +squad. The officer in charge of the train handed in a list of the number +of wounded on the train, classified into lying-down and sitting-up +cases, those of gravity being specially marked. The train was then +emptied carriage by carriage of the sitting-up patients, who walked to +the hospital or were driven by the motor ambulances as the case might +be, tally being kept at the door of the carriage. As soon as the train +had been emptied of the sitting-up cases, the cot patients were removed +by the stretcher squad to the motor ambulances, each of which carried a +load of two patients. In serious cases an officer was sent with the +patient, and as the distance was less than a quarter of a mile, the +transfer was fairly rapid. + +The Egyptian ambulance trains were on the whole good, and were equipped +with necessaries and comforts by the Australian Branch British Red +Cross. The Australian military authorities also provided nurses for the +trains. The stretcher squads soon learned and did their work exceedingly +well; but however well the work may be done, the removal of a gravely +injured man from a mattress in a wooden bunk to a stretcher offers some +difficulty and may cause distress. The construction of the wooden bunks +left something to be desired. There is no doubt that it is desirable to +devise a carriage of such a nature that stretchers can be inserted +without difficulty under every patient, and his removal effected without +disturbance. + +The patients on arrival in the front hall of the hospital were provided +with hot chocolate and biscuits, or with lime juice, and were at once +drafted to various portions of the hospital. The lighter cases were sent +to the auxiliary hospitals, and the more severe cases transferred to +wards in the Palace building. Four sets of admitting medical officers +with staffs were in readiness, and 200 patients could be disposed of in +an hour. Promptitude was essential, as the trains sometimes followed on +one another quickly. On admission the patients were bathed and given +clean pyjamas. Their clothes and kit were sent to the Thresh Disinfector +to be sterilised before being passed into the pack store. + +Every patient on entering the hospital was provided with pyjamas, shirt, +two handkerchiefs, socks, plate, knife, fork, spoon, mug, and slippers. +The Red Cross Society provided him with writing-paper and envelopes, +pencil, chocolate, nail brush, soap, cigarettes, tooth powder, and tooth +brush. + +[Illustration: THE LAKE, LUNA PARK, HELIOPOLIS. +_To face page 48_]] + +As the equipment of additional beds involved the supply of all these +articles, in addition to mattresses, blankets, linen, towels, kitchens, +cooking-utensils, stoves, bedside tables, ward utensils, instruments, +drugs, and bandages, the strain on the Quartermaster's department during +this period of expansion was very great. The supply and distribution of +food to the auxiliary hospitals occasioned considerable difficulty at +the beginning of the crisis, but was satisfactorily adjusted. + + +THE AUXILIARY HOSPITALS + +As the patients became convalescent they were moved to one of the +auxiliary hospitals, and from the auxiliary hospitals to one of the +convalescent hospitals at Helouan or Alexandria, and thence either +invalided or discharged to duty. As the patients during transference to +the auxiliaries were conveyed in a motor ambulance, and when transferred +to Helouan or Alexandria were motored to Cairo railway station under +charge of a N.C.O., some idea of the work thrown on the motor ambulance +corps and on the staff can be imagined. + +So far all the auxiliary hospitals were regarded as wards of the main +hospital, and administered from the main building--the only possible +method of administration at this juncture. It was generally believed +that the Dardanelles campaign would be of short duration, and that Luna +Park and the other auxiliary hospitals would soon be closed. +Consequently the expenditure of much money on these auxiliaries was +deprecated. When, however, it became obvious that the operations at +Gallipoli might last a very long time, and that in any event the troops +pouring into Egypt from Australia and elsewhere would require hospital +accommodation, an entirely new view of the matter was taken, and active +steps were taken to permanently equip the auxiliary hospitals for more +serious work. Of this equipment something must now be said in detail. + +At Luna Park the central lake was emptied and drained, and was covered +by an enormous shelter shed provided by the Australian Red Cross. The +shelter with a modern kitchen provided by the authorities formed the +dining-room for the patients, nearly all of whom were able to leave +their beds. In addition an excellent operating-room was built in brick, +barbers' shops were organised, and a canteen, store, and numerous +comforts in the way of blinds, sunshades, punkahs, were provided. Ample +bath and latrine accommodation was added. As time passed, the palm beds +were gradually replaced by metal beds, and the total number reduced to +1,000. In the event of another emergency, beds can be again provided, to +the number of 1,650, but such a step will only be taken in the presence +of necessity. + +Furthermore in the case of Luna Park and the other auxiliary hospitals, +the D.M.S. Egypt decided that the feeding of patients should be effected +by contract, and the matter was therefore left in the hands of a +well-known caterer. A large amount of Red Cross money was expended on +the shelter sheds and on a recreation hut managed by the Y.M.C.A., and +Luna Park became an excellent open-air hospital. It is the more +necessary to draw attention to this fact by reason of the adverse +criticisms which have been passed by those who have only a superficial +acquaintance with it. It will be sufficient to say that up to November +1, 5,500 patients had passed through it, and there had been only one +death, and that from anæsthetic. This remarkable result was not +altogether due to the fact that mild cases were admitted, for latterly +many major operations had been performed, for appendectomy, etc., and +according to Colonel Ryan, Consulting Surgeon to the Force in Egypt, all +the operation cases had healed by first intention. In fact Luna Park +really represents the triumph of the open-air method of treating +patients in a rainless country. The patients preferred it because of the +freedom the gardens gave them, but they showed one peculiarity which +could never have been foreseen. The Australian soldier was not very fond +of chairs. He did not want to stay in the shelter sheds, but preferred +to spend much of his day lying in bed, and had to be ordered away from +it to effect any change. It is not unnatural that men who have been +doing excessive physical work should prefer physical rest when they can +get it. + +[Illustration: THE SPORTING CLUB, HELIOPOLIS. +_To face page 51_]] + +At No. 2 Auxiliary Hospital, the Atelier, similar changes were made. The +Red Cross provided shelter sheds and a number of comforts. The Atelier +was certainly the easiest of the buildings to adapt, by reason of the +relatively small number of patients and its spacious surroundings. + +At No. 3 Auxiliary Hospital the building could not accommodate more than +250 patients in any circumstances, but two large tennis courts were +covered with matting and provided with a louvred roof. This proceeding +was followed by the erection of wooden huts each of which constituted a +ward of 50 beds. These huts were placed in convenient relationship to a +central kitchen and other conveniences. The Sporting Club thus became an +excellent outdoor hospital. + +The creation of the Infectious Diseases Hospital at Abbassia is another +instance of the importance of prevision. It was organised by Major Brown +(who had already organised Luna Park and the Atelier) as a hospital of +250 beds. By successive squeezes, and by the erection of tents, the +accommodation was rapidly increased to 1,250 beds, and was then +insufficient although typhoid cases were not admitted. + +The work of extension was at first difficult, but soon became quite +simple because a considerable number of officers and men became +experienced in the methods of effecting desirable results, and in the +art of adapting means in sight to the end desired. + + +THE CONVERSION OF THE AUXILIARY HOSPITALS INTO INDEPENDENT COMMANDS + +Finally it became obvious that the mechanism was becoming too +complicated, _i.e._ that the administration of all these hospitals from +the Palace Hotel, and the keeping of the records at the Palace Hotel, +had become impossible. It was accordingly decided to separate them and +make them independent commands. This arrangement was completed about the +middle of August, but it involved a fresh crop of difficulties. It was +quite necessary that some one should meet the trains and allot the +patients to the various hospitals. That was a comparatively simple +matter. It was necessary that the hospitals should be properly staffed, +and that those who administered them should receive proper rank, in +other words that there should be a definite establishment. This +necessitated a reference to the Australian Government, and consequently +difficulties and delays. + +[Illustration: THE SPORTING CLUB, HELIOPOLIS. +_To face page 52_]] + +The valuable and almost essential part played by the Australian Branch +British Red Cross, in effecting the expansion and in preventing a +disaster, will be referred to in the chapter on the Red Cross. + +The following table indicates the nature of the increasing demand on the +hospital accommodation: + + GROWTH OF THE HOSPITAL (FIRST AUSTRALIAN GENERAL) + _Hospital opened on January 28_ + + Venereal and + Infectious Cases + + Feb. 13 186 cases 358 cases + Feb. 15 200 cases (39 Ophthalmic and + aural cases) 351 " + Feb. 25 324 cases (including 51 special + cases) 422 " + March 1 477 cases, 46 special cases 404 " + March 15 532 " 57 " " 476 " + April 1 596 " 64 " " 283 " + April 15 567 " 52 " " 429 " + April 28 479 " 57 " " 433 " + April 29 631 " 57 " " 478 " + April 30 1,082 " 49 " " 469 " + May 1 1,324 (286 patients discharged) 456 " + May 2 1,465 (213 patients discharged) 462 " + May 3 1,492 453 " + + Patients admitted to July 31, 1915 13,325 + Deaths 102 = 0·76 per cent. + +Largest number of patients admitted on any one day (June 8, 1915): + + Australians 408 + New Zealanders 85 + British 325 + Officers 10 + ----- + 828 + ----- + June 9 219 + ----- + 1,047 in two days. + ===== + +Sick and wounded received at the First Australian General Hospital at +the end of April: + + April 28 195 + April 29 469 + April 30 529 + May 1 354 + ----- + Total 1,547 + ----- + +Surveying in retrospect this anxious and troublesome period, the +outstanding feature is the mistake made in the constant assumption that +the hospital expansion was temporary. It was stated that Luna Park would +only be wanted for a few weeks; the Dardanelles campaign would soon be +over, Luna Park would not then be wanted, and could be closed, +consequently heavy expenditure on it was deprecated. Furthermore the +experience gained makes it obvious that in war the Service cannot +include too many medical officers--preferably juniors. The demand for +their services here and there is practically unlimited. They should be +young and unattached to any particular unit--in fact a junior reserve on +the spot. + +It should be remembered that the expansion of No. 1 Australian General +Hospital was effected under the personal direction of the officer +commanding, Lieut.-Colonel Ramsay Smith, who inspected all new +buildings, gave his approval or disapproval, and was responsible for +their efficient equipment when converted into hospitals. + + +FOOTNOTES: + +[1] Including Luna Park. + +[2] 20 Reinforcements. + +[3] 38 Reinforcements. + +[4] 195 Reinforcements. + +[5] Auxiliaries separated and made independent. + + + + + CHAPTER V + + CONVALESCENT DEPOTS--EVACUATION OF CONVALESCENT SICK AND WOUNDED + FROM CONGESTED HOSPITALS--KEEPING THE HOSPITALS FREE--LIBELS ON + THE EGYPTIAN CLIMATE--DISCIPLINE. + + + + + CHAPTER V + + +It will be remembered that so far as the Australian troops were +concerned, provision had been made for three convalescent hospitals or +homes. The magnificent hotel of Al Hayat at Helouan was taken over on +May 5, emptied of hotel furniture, fitted with palm beds and mattresses, +and converted into a convalescent hospital. As there was no staff in +Egypt available, it was placed under the direction of a military +commandant and a principal medical officer who was a civilian +practitioner resident at Helouan. A few non-commissioned officers and +orderlies were transferred to it from the convalescent camp in the +desert at Zeitoun, which was very properly terminated. The cooking was +effected by arrangement with a professional caterer at a charge of 5_s._ +a day for officers, and 3_s._ a day for men. These charges ultimately +included the provision of cooking and eating utensils. This convalescent +hospital both in its general character and with respect to the food +supplied represents in all probability the most successful effort made +in Egypt. In fact it has been suggested that the hospital was almost too +attractive, and that there was consequently a good deal of +disinclination to leave it. In favour of the principle involved in +installing a military commandant to administer a convalescent hospital +there is much to be said, as the administration is one man's work. + +MONTHLY MEANS, WET BULB TEMPERATURE + + ----------+-----+-----+-------+-------+-----+------ + | Jan.| Feb.| March.| April.| May.| June. + ----------+-----+-----+-------+-------+-----+------ + Alexandria| 53·4| 54 | 56·5 | 60 | 64·2| 71·2 + Heliopolis| 51·8| 52·7| 57 | 59·7 | 64·9| 72·3 + Helouan | 50 | 50 | 53·8 | 57·4 | 61 | 67·3 + ----------+-----+-----+-------+-------+-----+------ + + ----------+------+--------+------+-----+-----+----- + | July.| August.| Sept.| Oct.| Nov.| Dec. + ----------+------+--------+------+-----+-----+----- + Alexandria| 73·4 | 73·8 | 69 | 66 | 61·2| 56·9 + Heliopolis| 73 | 74 | 70·2 | 65·7| 60·1| 54·7 + Helouan | 68·9 | 69·2 | 68·2 | 62·4| 57·6| 52·7 + ----------+------+--------+------+-----+-----+----- + + Maximum at Helouan, 77·3. Minimum at Helouan, 36·7. + + +THE EGYPTIAN CLIMATE + +Those who know Helouan and the hotel will not be surprised at the +success of the Hospital, but it may surprise even those who know Egypt +to learn that Helouan is considerably cooler than Cairo, notwithstanding +the fact that it is situated on the edge of the desert. Owing to dryness +the Wet Bulb temperature is considerably lower than at Cairo in +midsummer and the nights are always cool. + +It must be remembered that the figures in the attached table give means +only, and that any registration over 75°F. Wet Bulb is high, and that at +80°F. Wet Bulb work becomes difficult. At 90°F. Wet Bulb the danger +point is reached, and all work must cease on pain of death from heat +apoplexy. + +It will be seen, then, that Egypt is not especially hot, even from May +till October, and that Helouan is particularly cool. These conclusions +coincide with the feelings of those who live there. Alexandria is +pleasant by day, because of the sea breezes, but at night most people +prefer Heliopolis, which is drier and where they are more likely to +enjoy a breeze. + +[Illustration: ENVIRONS OF CAIRO +The Red Cross indicates Medical Stations of special interest to the +Australian Force. +_To face page 58_]] + +[Illustration: HELIOPOLIS PALACE HOTEL: CONVALESCENTS ON THE PIAZZA. +_To face page 59_]] + +These observations apply to the weather after May. From March to May the +khamsin may blow for several days. The temperature then is high, but the +air very dry. Khamsins usually cease in May. + + +CONVALESCENT HOSPITALS + +The Ras el Tin Convalescent Hospital at Alexandria was organised on +similar principles to those adopted at Al Hayat, for those who required +seaside change and sea bathing. At a later period half the accommodation +in the Montazah Convalescent Hospital was rendered available to +Australians. The Montazah Hospital will be described under the heading +of Red Cross. + +By the use of these three convalescent hospitals, accommodation was +provided for 1,500 patients, but in case of necessity at least another +800 could have been accommodated. In addition a large convalescent camp +was erected at Zeitoun in case of emergency. After the engagement in +August, a very great rush of wounded was expected, and had the hospitals +and convalescent homes been really taxed the convalescent camp would +have been utilised for overflow purposes. Fortunately this did not +become necessary, but the experience of May had given sufficient warning +of possibilities. + +The normal progress, then, of a patient admitted to No. 1 General +Hospital suffering from a serious wound or a serious disease of +non-infectious character was removal to one of the auxiliary hospitals +when he reached the semi-convalescent stage, and removal to one of the +convalescent hospitals when he reached the convalescent stage. From +these hospitals he was discharged to duty. + +Now, Helouan is twenty miles from Cairo, and can be reached by railway +or motor ambulance; and the railway station in Cairo for Helouan is +eight miles from Heliopolis. As the patients were moved from Heliopolis +to Helouan in scores or even hundreds at a time, some idea of the tax +imposed on the motor ambulance corps can be imagined. During the crisis +of May, June, and July, a visitor could witness an eternal procession of +trains discharging wounded at Heliopolis, of trains discharging wounded +at Cairo for other hospitals, of sick being moved to and from the +different hospitals in Cairo, and convalescents from the various +hospitals being sent to the Cairo station for Alexandria or to the Bab +el Louk station for Helouan. Without an adequate supply of motor +ambulances such an organisation would have been impossible. + +It should be understood that the convalescent hospitals were available +not only to all Australian sick and wounded from any hospital, but also +to British or New Zealand sick and wounded. The adjustment of accounts +between the separate Governments was a matter of discussion, and it was +finally agreed that in the case of hospitals no charges should be made +by reason of the section of the force to which the sick or wounded man +belonged. It was desirable as far as practicable to send the Australians +to Australian hospitals, but if the treatment of the sick and wounded +necessitated it, no hard-and-fast distinction was to be observed. In the +case, however, of convalescent hospitals, in which the matter could be +dealt with in a more leisurely way, the respective Governments were +charged the cost of maintenance of soldiers belonging to them. + + +ARMY MEDICAL ADMINISTRATION + +When the _Kyarra_ arrived in Egypt the military medical arrangements in +that country were on a very small scale, and under the administration of +the D.M.S. they rapidly enlarged. But the unexpected rush on April 29 +found the British Medical Force to a considerable extent, and justly, +dependent on the Australian Force for hospitals, medical officers, +nurses, transport, specialists, and Red Cross stores. As there is really +only one service and one object in view, it is quite unnecessary to +emphasise the satisfaction felt by Australians in being of substantial +service at a critical time. Since then the development of the medical +services has steadily proceeded, and the anxiety of May, June, and July +is never likely to be experienced again. + + +DISCIPLINE + +A word must be said on the subject of discipline and its influence on +Australians. The bravery and resourcefulness of Australians in the field +are sufficiently attested by those competent to judge. Of their splendid +behaviour when desperately injured we have had ample evidence, which we +furnish with proper respect to brave men. + +The convalescent Australian presents another problem, as also does the +soldier waiting at the base. The lines in Dr. Watts's hymn come to +mind. In these circumstances his very fine qualities cause him to give +trouble. His ingenuity in breaking bounds is worthy of a better cause. + +For example, there were complaints from the military police that sick +men were roaming about Cairo at night. The roll was called at No. 1 +General Hospital several times, and no one was absent. Not quite +satisfied, we called the roll in the Ophthalmic Ward one evening at 8 +p.m. Only one man was absent. Still suspicious, we called it again at +8.40 p.m. the same evening, and twenty-one men had gone. Some had rolled +up coats or blankets and so placed them that it seemed that the men were +still in bed. Subsequently uniforms that should have been in the pack +store were discovered under their mattresses. + +These and similar difficulties were aggravated by the fact that even a +moderate disciplinarian did not always receive the support of the nurses +or even the medical officers. + +To illustrate: An endeavour was made to limit smoking in the wards to +reasonable hours, as it has become an unfortunate tradition that a sick +soldier may smoke cigarettes all day long, when in bed, without injury. + +One of us (J. W. B.) entered a small ward which was filled with smoke, +and was just in time to see a sick man practically blowing smoke into a +nurse's face; needless to say the cigarette vanished with astonishing +rapidity. Looking through the murky atmosphere, I asked the nurse +whether she had seen any one smoking, to which she unblushingly replied, +"No, sir." + +If nurses and a section of officers throw their weight against +enforcement of discipline, because they don't think it necessary or +right, the difficulties become considerable. + +Again, the sentries were often in collusion with the men. Two instances +suffice: A soldier got out of the hospital through a hole in the fence. +On returning he determined to test the sentry with an eye to future +escapades. Walking up to the gate, he said, "I want to visit a friend." +"Have you got a pass?" said the sentry. "No," replied the sick man. A +discussion followed, and finally the sentry said, "Go in and out by the +hole in the fence; it will save me a lot of trouble." + +Yet another amusing incident. Sitting on the great Piazza at Heliopolis +were a number of men convalescent from serious illness, pneumonia and +the like. + +A short distance away on the outside of the iron railing fence, the +Arabs were conducting illicit and prohibited trade with the men inside, +and a sentry appointed to prevent it was walking up and down studying +astronomy. + +The Commanding Officer witnessed the occurrence, visited the happy +scene, interrogated the sentry, and asked him what his duties were. The +sentry answered, "To walk up and down here with me gun to prevent them +prisoners" (the unfortunate convalescents) "coming down them steps, and +to prevent them niggers jumping the fence!" + +The hardest part of military work is waiting. The soldier who has the +magnificent fundamental qualities of the Australian, and who can wait +and obey, would be the greatest soldier on earth. We are hopeful that +the experience gained will render the Australian the claimant for this +coveted position. All thoughtful Australian officers we know tell the +same story: "Give us discipline, and again and again discipline." + +There is much to be said for the soldier. He will obey if he knows why +an order is given, or if he trusts his officer and knows why it is +given. But if he is uncertain on these points he pleases himself. +Discipline cannot be enforced in general, except by properly trained +professional officers. + +Again, there was more drunkenness than there should have been from the +same cause. One evening visitors passed liquor into hospital, and a +hideous din arose. On seeking the cause, I discovered it to proceed from +a ward containing three patients, of whom one had a broken leg and +another a broken arm. + +These two men were uproariously drunk, and were sitting up in bed making +Australian political speeches. On my entry he of the broken leg demanded +in broken tones to be at once paraded before the orderly officer. + +On another occasion a particularly nuggety patient had broken the rules, +and becoming troublesome was ordered back to his ward. Refusing to go, +the guard was sent for, and a fight of a desperate character ensued +before he was overpowered; yet we found accidentally that later on this +man was made a N.C.O. and apparently gave satisfaction. + +In other armies such an offence might have been punished with death. + +On reading the account of the life of Stonewall Jackson it is clear that +similar difficulties were experienced with the Confederate soldiers, and +that Jackson against his inclination was compelled to enforce grave +penalties at times to prevent still graver trouble. + +It takes several men on the lines of communication and at the base to +keep one man at the front, and only loyal obedience to orders during the +wearisome and exacting day's work on the lines of communication will +make the machine run smoothly, and do justice to the man in the line of +battle who is risking his life. + +Yet it seems to us there is much to be done by attention to the +soldiers' social wants. The work of the Y.M.C.A. and the provision of +soldiers' clubs were powerful influences in favour of good order and +conduct. + + + + + CHAPTER VI + + EVACUATION OF THE UNFIT--RELIEVING THE PRESSURE ON THE HOSPITALS + AND CONVALESCENT DEPOTS--BACK TO DUTY OR AUSTRALIA--METHODS + ADOPTED--TRANSPORT OF INVALIDS BY SEA AND TRAIN. + + + + + CHAPTER VI + + +It became evident, both during the crisis and before the expected attack +in August, that Egypt must be cleared of those who were not likely to be +fit for service in the immediate future. The necessary effort made to +send invalids away for change, and to send the permanently disabled +home, involved important questions of policy the determination of which +took time. A number of problems at once obtruded themselves. Who was to +be permanently invalided, and how was the determination to be reached? +Who was to be sent away temporarily, and for how long was he to go? +Where was he to be sent to? What was to be done with malingerers, of +whom there was a small but sufficiently numerous percentage? As regards +the first question: is a man, for example, who has lost an eye +permanently invalided? Is he fit for base duty in Egypt, or must he be +sent home? It is hardly fair to send him to the front and expose him to +the risk of total blindness. In this particular case, in view of the +possibilities of the development of ophthalmia in Egypt--which, by the +way, did not prove nearly as serious as was anticipated--it was decided +that the man who had lost one eye should be sent home as permanently +unfit. Men who had lost a limb were put in the same category. It might +be argued that such men were quite fit for clerical work, and that +one-eyed men were quite fit for ordinary guard work, for which, indeed, +the demand was overwhelming. The view already indicated, however, was +taken, and these men were sent to their homes to be discharged. But when +these definite and obvious cases were disposed of, there remained some +thousands of men whose cases were full of difficulty. In each hospital +Boards were accordingly appointed to investigate their cases and to +fully answer the questions set out in the following Army Form B 179. + + + MEDICAL REPORT ON AN INVALID + (Taken from Army Form B 179) + + 8. DISABILITY + STATEMENT OF CASE + + NOTE.--_The answers to the following questions are to be filled + in by the officer in medical charge of the case. In answering + them he will carefully discriminate between the man's + unsupported statements and evidence recorded in his military + and medical documents. He will also carefully distinguish cases + entirely due to venereal disease._ + + 9. Date of origin of disability. + + 10. Place of origin of disability. + + 11. Give concisely the essential facts of the history of the + disability, noting entries on the Medical History Sheet bearing + on the case. + + 12. (_a_) Give your opinion as to the causation of the + disability. + + (_b_) If you consider it to have been caused by active service, + climate, or ordinary military service, explain the specific + conditions to which you attribute it. (_See_ NOTES _on p._ + 71.) + + 13. What is his present condition? + + _Weight should be given in all cases when it is likely to + afford evidence of the progress of the disability._ + + 14. If the disability is an injury, was it caused-- + + (_a_) In action? + (_b_) On field service? + (_c_) On duty? + (_d_) Off duty? + + 15. Was a Court of Inquiry held on the injury? + + If so--(_a_) When? + (_b_) Where? + (_c_) Opinion? + + 16. Was an operation performed? If so, what? + + 17. If not, was an operation advised and declined? + + 18. _In case of loss or decay of teeth._ Is the loss of teeth + the result of wounds, injury, or disease, directly[6] + attributable to active service? + + 19. Do you recommend-- + + (_a_) Discharge as permanently unfit, or + (_b_) Change to England? + + -------------------------------- + _Officer in medical charge of case._ + + I have satisfied myself of the general accuracy of this report, + and concur therewith, _except_[7] + + _Station_---------------- + _Officer in charge of Hospital._ + _Date_---------------- + + + OPINION OF THE MEDICAL BOARD + + NOTES.--(_i_) Clear and decisive answers to the following + questions are to be carefully filled in by the + + Board, as, in the event of the man being invalided, it is + essential that the Commissioners of Chelsea Hospital should be + in possession of the most reliable information to ENABLE THEM + TO DECIDE UPON THE MAN'S CLAIM TO PENSION. + + (ii) Expressions such as "may," "might," "probably," etc., + should be avoided. + + (iii) The rates of pension vary directly according to whether + the disability is attributed to (_a_) active service, (_b_) + climate, or (_c_) ordinary military service. It is therefore + essential when assigning the cause of the disability to + differentiate between them (_see_ Articles 1162 and 1165, Pay + Warrant, 1913). + + (iv) In answering question 20 the Board should be careful to + discriminate between disease resulting from military conditions + and disease to which the soldier would have been equally liable + in civil life. + + (v) A disability is to be regarded as due to climate when it is + caused by military service abroad in climates where there is a + special liability to contract the disease. + + 20. (_a_) State whether the disability is the result of (i) + active service, (ii) climate, or (iii) ordinary military + service. + + (_b_) If due to one of these causes, to what specific + conditions do the Board attribute it? + + 21. Has the disability been aggravated by-- + + (_a_) Intemperance? + (_b_) Misconduct? + + 22. Is the disability permanent? + + 23. If not permanent, what is its probable minimum duration? + + _To be stated in months._ + + 24. To what extent is his capacity for earning a full + livelihood in the general labour market lessened at present? + + _In defining the extent of his inability to earn a livelihood, + estimate it at ¼, ½, ¾, or total incapacity._ + + 25. If an operation was advised and declined, was the refusal + unreasonable? + + 26. Do the Board recommend-- + + (_a_) Discharge as permanently unfit, or + (_b_) Change to England? + + Signatures:-- + ------------ + _President_. + ------------ + _Members_. + + _Station_ ------------ + _Date_ ------------ + + APPROVED. + + _Station_ ------------ + ------------ + _Administrative Medical Officer_. + + _Date_ ------------ + + +It should be remembered that the bulk of the medical officers were +civilians, that they were unaware of the broad questions of policy +involved, and that they were inclined on principle to give a holiday to +a man who had been fighting, and even to believe the stories told them +by the malingerer. The reader will therefore not be surprised to learn +that a number of men who were certainly not in a very bad way were +recommended for two, three, or six months' change, or even for +discharge. The proceedings of the Board were reviewed by a responsible +officer; for a long time by Lieut.-Col. Barrett when acting as A.D.M.S. +on General Ford's staff. It was, however, difficult to persuade any +Board which had once expressed their opinion to modify it, and almost +impossible to get them to reverse it. If their recommendations had been +rejected altogether, the conduct of the Service would have become +difficult. Under direction, an attempt was made to modify the practice +by appointing a permanent Board in each hospital, presided over by a +senior medical officer charged with the duty primarily of attending to +Board work, and of acting as a clinician only when he had time. + + +THE FOLLOWING DRAFT WAS MADE THE BASIS OF THE ARRANGEMENT + +1. Two medical officers are to be detached from other duties at Nos. 1 +and 2 Australian General Hospitals respectively, in order to form a +majority of a permanent invaliding board at each hospital. They will be +known as the senior and junior invaliding officer respectively. + +2. The duties of the Board at Nos. 1 and 2 Australian General Hospitals +will be to form an Invaliding Board by meeting in each case the medical +officer in charge of the case. + +3. The Board proceedings when completed will be sent to the A.D.M.S. +Australian Force, Headquarters, Cairo, and on being approved will at +once be forwarded with nominal roll to the Australian Intermediate Base +Depot, Cairo. + +4. The Australian Intermediate Base will forward to the O.C. Hospital or +Convalescent Home nominal roll of patients who are to be discharged or +transferred to Australia or England. These patients will be transferred +to the Convalescent Home, Helouan (if they are able to leave hospital), +and will remain at the Home till transport is ready for them. + +5. The only circumstances in which completed Board cases are to be +retained in any hospital, except the Convalescent Home, Helouan, are +when patients require a considerable amount of treatment, and are unfit +to leave the hospital. + +6. The senior invaliding officer will be responsible for the accuracy of +the nominal rolls. + +7. At Alexandria an invaliding officer will be attached to the +Australian Convalescent Home at Ras el Tin. It will be his duty, under +direction of the A.D.M.S. Alexandria, to proceed to the various +hospitals and camps in Alexandria, arrange for the formation of Boards, +of which he will be a member, to deal with all cases in Alexandria. +These cases, in like manner, must be forwarded to Convalescent Home, +Helouan, except in the cases of those who are unfit to leave hospital. + +8. The cases to be dealt with fall into two classes: (_a_) men unfit for +military service, who may be sent by (i) transport to Australia or (ii) +by hospital ship to Australia; and (_b_) men likely to profit by change +to England during hot weather, to proceed by (i) transport or (ii) +hospital ship. + +9. The Board proceedings are to indicate, in the opinion of the Board, +the best manner of dealing with patients under the several headings. + +_June 30, 1915._ + + +Again difficulties arose, since none of the medical officers wanted the +job. In fact, medical officers in general never want to do anything +except attend to patients. They are unsuited temperamentally for +administrative work, and dislike it. Even with this modification, though +the system worked somewhat better, evils obtruded themselves. The +statements of men who swore they were suffering from rheumatism and +severe pains in the back were sometimes taken at face value, and further +modification consequently became necessary. Any medical officer could +recommend any patient to be boarded. The Board then sat and sent in its +report to the A.D.M.S. Under the modified arrangement no patient could +be boarded until he had been examined by the senior medical officer of +the Australian Force in Egypt, or by the D.D.M.S. Egypt, Col. Manifold. +By this means most of the trouble was eliminated and a satisfactory +principle was established. It is the old story--the reversion to +direction by a limited number of experienced and responsible people. + +It was decided not to send Australian patients to Great Britain other +than in exceptional cases, that is if they had friends or relatives +there, and if they only required a short change, say two months. As the +voyage to Australia occupied a month each way, it was absurd to send +them back there for two months. For three months or more they were sent +to Australia, and in some cases were discharged on arrival. Some men who +were no longer fit for service at the front were kept in Egypt for Base +Duty. + +Only those who have experience of base work become aware of the enormous +demands made on a garrison for guard work, for clerical work, orderly +work, and the like. At Al Hayat, Helouan, for example, the commandant +really required ninety men for sentry work, though he had only forty. +The demands for competent clerks were incessant. + +[Illustration: THE EASTERN MEDITERRANEAN. +The Red Cross indicates Medical Stations of special interest to the +Australian Force. +_To face page 77_]] + +As soon as patients were destined for dispatch to Australia they were +forwarded to Helouan and kept there until the ship was ready to leave. +As a result Helouan was filled with waiting cases. In order then to ease +the pressure at Helouan, a waiting camp was established at Suez close to +the Government Hospital, to which any patients could be admitted. This +establishment of course necessitated further demands for medical +officers, orderlies, etc. + + +TRANSPORT OF SICK AND WOUNDED BY SEA + +As soon as it was decided to return patients to Australia in addition to +those sent to England, Cyprus, or convalescent hospitals in Egypt, a +system was developed in order to provide the necessary staffs and +equipment on ships. Surgeon-General Williams had exerted himself to get +hospital ships provided, but in the early stages they had not even been +promised, and a service was perforce created by utilising empty +transports and collecting the staff in Egypt. The first efforts may be +described as almost maddening. It was impossible to get adequate notice +when a ship was likely to leave for Australia. It had probably been to +the Dardanelles and unloaded soldiers and munitions of war. It had +returned to Alexandria packed with wounded. It might then be drafted to +Australia, at a few days' notice. It was necessary to clean and refit +it, to place hammocks, blankets, beds on board, to provide drugs and +surgical appliances and Red Cross stores, and to provide a staff in +Egypt. + +In looking back on the efforts made, the wonder is not that minor +defects occurred in the early stages, but that the work was done +anything like as well as it was. The difficulties were almost +insuperable, and nothing but the devotion of a number of medical +officers to the service rendered any decent result possible. + +The first ship to leave with wounded on board was the _Kyarra_ on June +7, but previously a number of ships had left containing invalids, +venereal cases, undesirables, and oddments. In every case there was a +scramble at the last moment to get things ready. The staff for the ships +was provided by detailing officers, nurses, and orderlies from the +scanty staffs of Nos. 1 and 2 General Hospitals. The Australian +Government, under request, then began to provide transport staffs who +came with the troopships and returned at later intervals when the +troopships went back again as "hospital carriers." Of hospital ships +proper there were none. Each ship was inspected in order to ascertain +the number of patients she could carry, and to determine the staff +requisite--consequently a routine procedure was adopted. Cot cases were +seldom taken, as it was thought better where possible to keep cot cases +in Egypt. A minimum of two medical officers was allowed for 300 +patients, and an additional medical officer for every 150 patients. One +trained nurse was allowed for every 50 patients, and one orderly for +every 25 patients. These numbers were arbitrary and approximate, but +served as a working basis. The supply was probably in excess of real +requirements, but it was necessary to contemplate the possibility of an +epidemic outbreak in the tropics and the grave results which might +ensue. The equipment of drugs and instruments was liberal, and was +arranged on a fixed plan worked out by the officer in charge of the +base medical store at Heliopolis. The Red Cross stores were supplied in +the same way, and the commanding officer was given a sum of money, +sometimes as much as £150 to £200, to spend on comforts for the men. A +canteen was placed on board in addition. The ship was not allowed to +leave the wharf until the commander had given a certificate that he had +on board all the medical comforts required by the Admiralty regulations, +and until the principal medical officer had given a certificate that he +had all that he required in the way of staff, drugs, surgical and +medical equipment, and Red Cross stores. + +There is no more dangerous branch of medical service than the transport +of sick and wounded over the ocean, since there are so many +possibilities of disaster. + + +BASE MEDICAL STORE + +These continual demands on personnel and on medical stores necessitated +suitable arrangements, and messages were sent to Australia asking for +reinforcements. In addition a large base medical store was established +at Heliopolis, and made an independent unit. It became the business of +the officer in charge of this store, Captain Johnson, to make up drugs +and surgical instruments per 100 patients, and to receive the surplus +stores from each of the incoming transports. Two hospital ships were +ultimately provided, the _Karoola_ and the _Kanowna_, and reached Egypt +in October. + + +CASES RETURNED TO AUSTRALIA FROM FEB. 3 TO SEPT. 25, 1915, AND REASONS + + Officers = O. Other ranks = O. R. + ----------+----------+----------+---------+----------+-----------+---------- + Medically| Venereal | Services | Other | Change | | Wounded + Unfit. | Cases. | no longer| reasons.| to | Total. | in + | | required.| |Australia.| | Action. + ---+------+---+------+----+-----+---+-----+---+------+----+------+---+------ + O.| O.R. | O.| O.R. | O. |O.R. | O.| O.R.| O.| O.R. | O. | O.R. | O.| O.R. + ---+------+---+------+----+-----+---+-----+---+------+----+------+---+------ + 29| 2,496| | 1,344| 5 | 215| 24| 49| 29| 1,154| 137| 5,258| 52| 1,571 + | | | | | | | | | | | | | + | | 450 also | | | | | | | | | | + | | sent to | | | | | | | | | | + | | Malta | | | | | | | | | | + ---+------+----------+----+-----+---+-----+---+------+----+------+---+------ + + +TRANSPORT OF SICK AND WOUNDED TO SUEZ + +The arrangements for conveying the invalids from Cairo to Suez were +interesting. They could not be conveyed to Alexandria or Port Said +because one passenger placed on a ship at those ports enormously +increased the charges made by the Suez Canal Company, and Suez was +consequently fixed upon as the port of departure and the port of +equipment. Patients to be conveyed to Suez were at Helouan, or at +different hospitals in Cairo, and accordingly two trains were made +up--one at Helouan and one at Palais de Koubbeh, Heliopolis. Each train +was filled at a specific time, the two trains conveyed to Cairo, a +junction effected in the Cairo station, and the whole conveyed to Suez. +The journey took about five hours, and the necessary provision was made +for feeding the men on the way. One of the difficulties in conveying +such patients was to prevent them riding on the platforms of the +carriages and falling off. A sentry was placed at each end of the +carriage to prevent the continuance of these disasters, which had been +too numerous in the case of healthy men in the troop trains. Men had +even lost their lives or been mutilated from trying to ride on the +buffers _à la Blondin_. + +[Illustration: The Red Cross indicates Medical Stations of special +interest to the Australian Force. +_To face page 80_]] + +On arrival at Suez the train proceeded alongside the ship, the patients +and their kit were moved on board, and a guard placed in the dockyard. +Even then men straggled into Suez, and their recapture gave some +trouble. The Australian is essentially a roamer. + +The table on page 80 indicates the number of soldiers returned to +Australia up to September 25, 1915, and the reason for their transfer. + + + +FOOTNOTES: + +[6] Loss of teeth on, or immediately after, active service, should be +attributed thereto, unless there is evidence that it is due to some +other cause. + +[7] Delete this word if no exceptions are to be made. + + + + + CHAPTER VII + + SICKNESS AND MORTALITY AMONGST AUSTRALIANS--THE DANGERS OF CAMP + LIFE--STEPS TAKEN TO PREVENT EPIDEMICS--NATURE OF DISEASES + CONTRACTED AND DEATHS RESULTING--DEFECTIVE EXAMINATION OF + RECRUITS--OPHTHALMIC AND AURAL WORK--THE FLY PEST--LOW + MORTALITY--THE EGYPTIAN CLIMATE AGAIN--SURGICAL WORK AND + SEPSIS--CHOLERA--INFECTIOUS DISEASES. + + + + + CHAPTER VII + + +In civil practice we had long been aware of the fundamental failing of +the medical profession. Its members operate in a community as +individuals. They seek to cure disease in general; they are +conscientious to a degree in the discharge of this duty, and they give +valuable personal advice respecting hygiene. But of the prophylaxis of +disease they have little trained knowledge, and they are not seriously +interested. The prophylaxis of disease really implies organised and +co-operative effort, and can only be effectively undertaken by those +public-health officials who are charged with it as a definite function. +In Australia at all events the inducements to enter the public-health +service as a profession are not very great. The influence of the +department is not very far-reaching, and the prophylaxis of disease is +still in its infancy. One can foresee the time when the number of +practitioners per 100,000 of the population will be fewer than at +present, and the number of public-health officials will be greater. The +transition from the one occupation to the other will only take place +when a much higher standard of general intelligence prevails in the +community. + +What applies to civil life applies to a lesser extent to an army, +because the headquarters staff of an army are as a rule excellently +informed respecting the risk run by neglect of sanitation. They +understand thoroughly that disease may do more harm than battles, and +that outbreaks permitted to get out of hand are with difficulty +controlled. In the Australian Army, by reason of its necessarily scratch +nature, there was practically no instruction in prophylaxis. It was +certainly not acutely understood, and the disastrous events which +attended the formation of camps in Victoria and elsewhere show that the +controlling authorities were either not fully informed of the risks, or +if informed, did not understand the best plan of action. What applied in +Australia was true to a lesser extent in Egypt, because Surgeon-General +Williams and many of the R.A.M.C. officers who controlled medical +operations in Egypt, and distinguished members of the Indian Medical +Service who were associated with them, had been through a number of +campaigns in South Africa and elsewhere, and were aware both of the +risks and the difficulties. Consequently some effort was made to avoid, +or to minimise the effects of, some of the disastrous outbreaks. + +In March and April, before the arrival of wounded, the number of cases +in hospital was a source of common comment amongst the medical officers, +who could not understand why healthy men under service conditions, +camped on the edge of a dry desert, should be suffering from serious +disease to such an extent. The diseases were for the most part measles, +with its complications, bronchitis, broncho-pneumonia, and a certain +amount of lobar pneumonia, infectious pleuro-pneumonia, and tonsillitis. +There were a few cases of cerebro-spinal meningitis. The impression made +on a physician who had all the cases coming from the Heliopolis camps +under his control was that these diseases were inordinately prevalent; +but the following figures, obtained from headquarters and forwarded to +the Government, show that while disease was more extensive than it +should be, it was not excessive. Including venereal disease, the cases +certainly did not exceed 6 to 8 per cent. of the force. + +[ILLUSTRATION: OFFICERS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL. +_To face page 86_]] + + +FIRST AUSTRALIAN GENERAL HOSPITAL + +_Memorandum prepared to show the Extent of Disease amongst Australian +Troops_ + + PALACE HOTEL, + HELIOPOLIS, + _May 8, 1915_. + +(Report begins) "The following figures have been obtained from the +office of the D.M.S. Egypt. Owing to the movement of troops out of +Egypt, comparisons are apt to be a little difficult to institute with +accuracy. Nevertheless the figures given substantially indicate the +position. + +On February 15 there were 1,329 patients in hospital. The number of sick +and off duty in the lines, but not in hospital, is not stated; but as it +amounted to 423 on February 1, and to 644 on March 1, it may be assumed +to be 500, which will give a total of 1,829 sick and off duty on +February 15. + +On March 1, 1,737 men were in hospital, 644 off duty and sick in the +lines, or a total of 2,361. + +On March 15, 1,429 were in hospital, 500 off duty and sick in the lines, +or a total of 1,929. + +On April 1, 1,217 were in hospital, 495 sick and off duty in the lines, +or a total of 1,712. + +The totals, therefore, off duty on the dates specified were: + + February 15 (approx.) 1,829 + March 1 2,381 + March 15 (approx.) 1,929 + April 1 1,712 + +It should be stated that the figures quoted above would have been very +much larger were it not that a large number of men unfit for duty by +reason of venereal and other forms of disease have been returned to +Australia, and a considerable number sent to Malta. + +There have been returned to Australia by the _Kyarra_ on February 2, the +_Moloia_ on March 15, the _Suevic_ on April 28, and the _Ceramic_ on May +4, a total of 337 soldiers who were medically unfit for various reasons, +and 341 suffering from venereal disease, or 678 in all. In addition +about 450 were sent to Malta. If these soldiers had been added to the +list of those reported sick and unfit for duty daily, the number would +have considerably exceeded 2,000. The estimate of 2,000 sick and unfit +for duty daily was studiously moderate, as pointed out in a private +letter to Colonel Fetherston at the time when precise figures could not +be immediately obtained. + +It is gratifying to find that the amount of sickness is diminishing and +that the amount of venereal disease, so far as can be ascertained, is +also decreasing. + +Strenuous efforts have been made by the A.M.C. to attack both forms of +inefficiency by dealing with the causes, and with a view to avoiding +future troubles the D.M.S. Egypt has appointed a committee of medical +officers to inquire into the causations of the outbreak. It is unlikely +that the committee can be very active just at present, because of the +prior claims on the time of all concerned owing to the influx of +wounded. At a later period it is hoped that an exhaustive report will be +furnished for the benefit of future undertakings. + +Most strenuous efforts have been made to limit the amount of venereal +disease. General Birdwood, Commander-in-Chief of the New Zealand and +Australian Army Corps, has personally interested himself in this +question, and has through the O.C. First Australian General Hospital +arranged for me to visit each troopship on arrival, all leave being +stopped from the transport until I have been on board. The practice +followed is to interview the commanding officer and the officers of the +transports, to explain to them the gravity of the position, and to ask +each and all of them to use all the influence he possesses with his men +to deter them from exposing themselves to the risk of contagion, to draw +their attention to the fact that on the physical fitness of the +individual man depends the possibilities of success to the army, and to +ask for the loyal and enthusiastic co-operation of every officer in work +of such importance from a military point of view, and the point of view +of subsequent civil life. The officers immediately parade the men, +address them, and convey to each of them a printed message from General +Birdwood. General Birdwood's letter to General Bridges, written during +the early part of the stay of the Army in Egypt, is handed to the +Commanding Officer to be read by him and his staff. There is no doubt +that this systematic procedure has drawn attention to the gravity of +the problem. It has always been responded to loyally by the officers +concerned, and it has certainly limited the action of young and +inexperienced men on their first landing in an Eastern country. + +Other steps were taken by Surgeon-General Williams, who on arrival in +Egypt called a conference of senior medical officers to consider the +gravity of the venereal diseases problem. + +It is satisfactory to find, notwithstanding the amount of disease which +has existed, and which, while not excessive, is still heavy, that the +mortality has not been as serious as it might have been. The mortality +in No. 1 Australian General Hospital for February and March was +seventeen cases out of a total of 3,150 admitted" (Report ends). + +The following return shows the total number of casualties in the +Australian Force up to July 16, 1915: + + ---------------+----------+-------------+------- + Casualty. | Officers.| Other Ranks.| Total. + ---------------+----------+-------------+------- + Killed | 110 | 1,598 | 1,708 + Died of Wounds | 46 | 740 | 786 + Wounded | 341 | 8,404 | 8,745 + Missing | 16 | 770 | 786 + Died of Disease| -- | 43 | 43 + ---------------+----------+-------------+------- + Totals | 513 | 11,555 | 12,068 + ---------------+----------+-------------+------- + +The next table shows the average length of stay in hospital of venereal +cases at a particular date: + + +FIRST AUSTRALIAN GENERAL HOSPITAL + + Total venereal cases admitted 1,288 + Average stay of patients 16 days + + +THE ENLISTMENT OF THE UNFIT AND ITS CONSEQUENCES + +Prior to the arrival of the wounded the medical service was +inconvenienced by another circumstance. Men were continually arriving +with hernia, varix, and other ailments which they had suffered from +before enlistment, and which had been overlooked during the preliminary +examination in Australia. In one case a soldier suffering from aortic +aneurism arrived in Egypt, and similar instances might be given. The +examination of recruits in Australia had been conducted by practitioners +in country towns and elsewhere, often under conditions highly unfair to +the practitioner. There is no doubt that the Government would have been +well advised to have withdrawn a few men from private practice +altogether, paid them adequate salaries, and made them permanent +examiners of recruits. Experience of war demonstrates most completely +the folly of sending any one to the front who is not physically fit. It +is apt to be forgotten that in warfare there can be no holidays, or days +off, and that the human being must be at his maximum of physical +efficiency, and his digestion of the best. If his soundness is doubtful +it is better to keep him for base duty at home, on guard duty at the +base, or as an orderly in the hospital. It is simply a waste of money, +and tends to the disorganisation of the service, to send such people +anywhere near the fighting line. We made an attempt at one stage to +roughly calculate what the Australian Government had lost in money by +the looseness of official examination. It was impossible to make an +accurate estimate, but the sum was great. + + +OPHTHALMIC AND AURAL WORK + +When one of us joined the hospital as oculist and aurist and registrar +(Lieut.-Col. Barrett) he was informed that specialists were not +required, but apparently those responsible had formed no conception of +the excessive demands which would be made on the ophthalmic and aural +departments. The first patient admitted to No. 1 General Hospital was an +eye case, and an enormous clinic rapidly made its appearance. It was +conducted somewhat differently from an ordinary ophthalmic and aural +clinic, in that (by reason of the remoteness of their camps) some +patients were admitted for ailments which would have been treated in the +out-patient department of a civil hospital. There were usually from 60 +to 100 in-patients and there was an out-patient clinic which rose +sometimes to nearly 100 a day. It should be remembered that these +included few, if any, serious chronic cases, which were at once referred +back to Australia. The amount of ophthalmic and aural disease was very +great. The figures subjoined show the extent of the work done. + +From the opening of the Hospital to September 30, 1915, the patients +treated in the Ophthalmic and Aural Department numbered as follows: + + Ophthalmic cases 1,142 + Aural, nasal, and throat cases 1,474 + There were 246 operations. + +The ophthalmic cases may be roughly classified as follows: + + Ophthalmia (chiefly Koch-Weeks and a percentage + of Diplo-Bacillary) 546 + Affection of lids 15 + Pterygium 8 + Corneal opacities 6 + Trachoma 17 + Iritis 12 + Cataract 8 + Foreign bodies in the eye 14 + Old injuries 9 + Detachment of retina 2 + Strabismus 16 + Concussion blindness 4 + Refraction cases: + (a) Hypertropia 210 + (b) Myopia 30 + (c) Hypertropic astigmatism 230 + (d) Myopic astigmatism 15 ---- 485 + ----- + 1,142 + ===== + + +AURAL, NASAL, AND THROAT CASES + + Acute catarrh (middle ear) 95 + Chronic " " " 315 + Cerumen 190 + Dry catarrh (Eustachian) 120 + Oto-sclerosis 138 + Otitis externa 143 + Concussion deafness 139 + Nasal catarrh 114 + Septal deflection 96 + Adenoids 74 + Polypi 4 + Enlarged tonsils 12 + Antra and sinuses 14 + Pharyngeal catarrh 11 + Aphonia 8 + Laryngeal growth 1 + ----- + 1,474 + ===== + + +OPERATIONS PERFORMED + + Ophthalmic + Excision 36 + Iridectomy and extraction 11 + Removal F.B. 7 + Pterygium 4 + Minor operations 6 + -- + 64 + == + + Aural + Mastoid operations 17 + Removal F.B. 3 + -- + 20 + == + + Nasal + Adenoids 73 + Spurs 34 + Polypi 14 + Tonsils 41 + --- + 162 + === + Total performed, 246 + +The distribution of disease is unusual. In the course of a long and +extensive practice one of us (Lieut.-Col. Barrett) had not seen as many +cases of adenoids in adults as he examined in Egypt in three months. It +seemed that the irritation of the sand containing organic matter caused +inflammation and irritation of the naso-pharynx. Of ophthalmia there was +a great deal. It was usually of the Koch-Weeks variety, and gave way +readily to treatment. There were a few cases of gonorrhoeal ophthalmia, +two of which arrived from abroad, and all of which did well. After the +arrival of the wounded, however, a new set of problems made their +appearance. A limited number of men were totally blind, mostly from bomb +explosions, and a large number of others had received wounds in one eye +or in the orbit. It soon became evident that an eye punctured by a +fragment of a projectile is almost invariably lost. The metal is +non-magnetic. It is usually situated deep in the vitreous; it is +practically impossible to remove it even if the eye were not infected +and degenerate. A still more remarkable phenomenon, however, made its +appearance. If a projectile enters the head in the vicinity of the eye, +and does not actually touch it, in most cases the eye is destroyed. +Whether from the velocity or the rotation of the projectile, the +bruising disorganises the coats of the eye and renders it sightless. In +all such cases, if the projectile was lodged in the orbit, the eye was +removed together with the projectile. The total number of excisions was +thirty-six. In no case did a sympathetic ophthalmitis make its +appearance. The eyes were not removed unless the projection of light was +manifestly defective. A fuller account of the precise ophthalmic +conditions will be published elsewhere. + +If the general physical examination of recruits was defective, it is +difficult to find suitable terms to describe the examination of their +vision. Instances were not infrequent where men with glass eyes made +their appearance, and there were several recruits who practically +possessed only one eye. Spectacle-fitting was the chief work, as many of +the recruits required glasses, mostly for near work, but sometimes for +the distance. Ultimately the War Office decided to provide the +spectacles. In such a war, it is impossible to exclude recruits for fine +visual defects, still, men with only one eye can hardly be sent to the +front. + +One remarkable instance occurred. A man suffering from detachment of the +retina had but one effective eye. I gave directions that he should not +be sent to the front, but he eluded authority, and reached Gallipoli, +where he was hit in the blind eye with a projectile. I subsequently +removed the eye. + +The work was excessive, but only one life was lost, though on occasion +the condition of some of the sufferers was grave to a degree. One of the +most remarkable cases of injury was that of a man who was struck below +the left eye by a bullet which emerged through the back of his neck, to +the side of the median line. The bullet in emerging tore away a large +quantity of the substance of the neck, leaving a hole in which a +fair-sized wine glass could have been placed. He was a cheerful man, and +sat up in bed propped with pillows, because of the weakness of his neck, +and observed to a visitor "Ain't I had luck!" He made an excellent +recovery. + +[Illustration: HELIOPOLIS PALACE HOTEL: ROTUNDA AND PIAZZAS. +_To face page 97_]] + +It is remarkable that there should have been so much refraction work, +and there is no doubt that a working optician, _i.e._ spectacle maker, +should accompany every army. Men are often just as dependent for their +efficiency on glasses as on artificial teeth, and in a war of this +character cannot be rejected. + +The acute inflammations of the middle ear were of the most severe type, +caused temperatures rising to 103° F. and sometimes left men on +convalescence as weak as after a serious general illness. The attacks +were so vicious that the pathologist, Captain Watson, sought for special +organisms, but found only staphylococcus. Probably the same group of +organisms which caused vicious pulmonary attacks also caused these +severe aural inflammations. + +Before our arrival in Egypt malingerers in the force who, having enjoyed +a holiday trip to Egypt, wanted to go home again, suddenly discovered +that they were blind or deaf. For a time the department was fairly busy +detecting the wiles of these men. When they discovered, however, that +they would be subjected to expert examination, sight and hearing soon +returned. A number of devices were resorted to in order to detect the +fraud--_i.e._ the use of faradisation, blind-folding, and the like--and +it was rarely that the impostor escaped. + + +OTHER DISEASES: MEASLES AND ITS COMPLICATIONS; FOOD INFECTIONS + +The danger run by an army from measles is very great indeed, and at an +early stage the position was surveyed, and an attempt made to limit the +trouble. A cable message was sent to Australia, asking that precautions +should be taken against shipping measles cases or contacts. At Suez +arrangements were made with the Government Infectious Diseases Hospital +to admit any patients suffering from measles or infectious diseases who +might land with the recruits. In such cases the clothing of the +remaining recruits was disinfected before they were allowed to proceed +to Cairo. In this way disease was kept out of Egypt as much as possible. +In the case of measles it is not simply temporary disablement, but also +the complications and sequelæ which are to be feared. The experience +gained has made us converts to the open-air method of treating such +cases, at all events in a rainless country like Egypt. Treated on +piazzas and in open spaces the cases seem to do better than in hospital +wards, and, as far as one can judge without a critical examination, with +a lower mortality. + +The extent to which the troops suffered from measles and other diseases +was the cause of the appointment of a committee to inquire into +causation. The committee made some inquiries, but owing to a set of +complications never completed its work. There seemed, however, to be a +consensus of opinion that the use of the bell tent was objectionable, as +it did not ventilate readily, and that the habits of the men contributed +to these diseases. + +The men were apt to visit Cairo, spend the evenings in the cafés or +theatres, ride home in the cold nights in a motor car or tram, get to +bed at the last moment possible, and then turn out again for a hard +day's work. The opinion of the physicians was that the drilling of men +suffering from even a moderate cold was a source of considerable danger. +If to these causes be added the neglect of the teeth on the part of many +of the men, some explanation may be found for the presence of these +diseases. Every effort was made to instruct the men through the +regimental officers, and there is no doubt that as time went on the +quantity of this type of disease somewhat diminished. + +Sunstroke was practically unknown. A number of cases occurred during a +severe khamsin, but the use of a looser and lighter uniform, and the +adoption of sensible hours of work, prevented any recurrence. Of two +deaths known to have taken place the cause was only partly due to heat. +The men were warned against the risk of bilharzia, and as they were +provided with shower baths there was no inducement to bathe in the muddy +pools and canals where bilharzia lurks. + +With the provision of dentists another risk was removed, at all events +in parts. In hospitals, tooth brushes were supplied in thousands, and +every effort was made to get the men to use them. + +As the summer wore on, however, another type of disease made its +appearance--the intestinal infections which, at first unknown, became so +frequent in Gallipoli as to be more serious than fighting. In Gallipoli +itself it is difficult to see how they could be prevented. In a limited +space there were many dead bodies scantily buried, and consequently +myriads of flies. The plentiful use of disinfectant, had it been +obtainable, might have been useful, but the difficulties were great. +Once the dysenteric organisms were introduced, it was practically +impossible to stop the spread of disease. + + +THE FLY PEST + +At the Island of Lemnos, however, which was not under fire, and where +there was room, the conditions appear to have been nearly as bad, and +it is somewhat difficult to know why the fly pest could not have been +got under at Mudros. At Heliopolis at an early stage the fly problem was +seriously tackled. A sanitary officer was appointed, and charged with +the duty of dealing with this important matter. The following +precautions were adopted. All refuse and soiled dressings were placed in +covered bins, which were provided in quantity. These were removed once +daily. Any moist ground in the vicinity of these bins was watered with +sulphate of iron solution, and sprinkled with chloride of lime. Fly +papers in great numbers were distributed throughout the wards. The food +in the kitchens, whether cooked or uncooked, was kept under gauze covers +or in gauze cupboards. By these means the fly pest was reduced to small +proportions. But with the least slackness in administration the flies +were again in evidence. It was most instructive to see a floor covered +with flies if fluid containing food material had been spilled, and to +see dirty clothing covered with masses of flies. A piece of soiled +clothing half buried in the desert appears to act as an excellent +breeding-place. + +It was impracticable in Egypt to cover all the windows and doors with +fly-proof netting. The exclusion of the air in the hot weather would +have been troublesome, and the best type of netting was not obtainable. +Furthermore the precautions already enumerated kept the pest under in +Heliopolis. + +The fly problem was one of the most serious the army had to face. The +passage of a dysenteric stool by a man who is really ill was often +followed by the entry into his anus of flies before an attendant had +time to intervene. Each of these flies might then become a source of +infection and had only to light on a piece of food, cooked or uncooked, +to cause further damage. + + + CIRCULAR ISSUED BY THE OFFICER COMMANDING THE HOSPITAL + _Destruction and Prevention of Flies_ + + _Outside._ + + 1. No rubbish heaps will be allowed. + + 2. All manure heaps shall be sprayed twice a week with sulphate + of iron--2 lb. to 1 gallon of water. + + 3. All food in the Arab quarters shall be kept in a closed + cupboard. + + 4. All rubbish boxes and open receptacles shall be removed from + the premises and neighbourhood. + + 5. No receptacles other than iron tins with lids kept closed + will be allowed to be used for refuse. + + 6. Every place on which garbage has been exposed shall be + freely sprinkled with chloriated lime. + + _Wards._ + + 1. All food and receptacles for food shall be kept constantly + covered. + + 2. All spit-cups shall be kept covered. + + 3. All remains of food shall be removed at once to receptacles + which are to be kept covered completely and constantly except + when uncovered necessarily to receive waste materials. + + 4. Sisters-in-Charge shall use a liberal quantity of fly + papers. Surgical soiled dressings shall be placed in special + bins which shall be kept covered. + + _Kitchen and Mess Rooms._ + + 1. All food shall be kept locked up or completely covered. + + 2. All remains of food shall be treated as in the wards. The + responsible officer shall use a liberal supply of flat or + hanging fly papers. + +It need hardly be said that the enforcement of even these simple +precautions is more difficult than giving the order. + +A good sanitary officer, however, acting on these directions, can and +did reduce the fly danger to small proportions. The flies were never +exterminated, but were kept well under. The least slackness, however, +ended in their rapid reappearance. As they are in all probability the +principal cause of the gastro-intestinal infections, the matter is one +of the first importance. + +Typhoid fever made its appearance, and a proper statistical +investigation should be made later on to show the extent of the damage +done. The general impression respecting the result of the inoculation to +which all the troops were subjected was that the disease was not so +frequent and certainly not nearly so fatal as it otherwise would have +been. Deaths were few. + +The men had not been inoculated against paratyphoid, so that exact +conclusions will be difficult to draw even when figures become +available. + +Many people suffered from Egyptian stomach ache, a form of disease which +is as unpleasant as it is exhausting. It manifests itself by repeated +attacks of colicky pain, apparently usually associated with the colon. +The severity of the pains is remarkable, and the persistent recurrence +speedily ends in a considerable degree of exhaustion. It is almost +certainly due to food infection. + +It is obvious that the business of a sanitary medical officer is not +merely to inspect buildings and kitchens, but to spend an hour or two a +day in the kitchen quietly watching the preparation of the food and +giving the necessary instruction and supervision to those who are +preparing it. The inefficiency caused by food infections has probably +done more harm than many battles. In the camps similar troubles +occurred. By reason of the lack of cold storage and the high +temperature, rotten food was not uncommon, and caused outbreaks of +incapacitating diarrhoea and ptomaine poisoning. + +When, however, the problem is surveyed dispassionately, the remarkable +feature of the work at Heliopolis and in Cairo was the low mortality, as +the following table will show: + +BURIALS IN OLD CEMETERY, CAIRO + +_From Arrival of Australians in Egypt, December 5, 1914, to August 14, +1915_ + + British Imperial Force 77 + Australian Imperial Force 155 + New Zealand Force 50 + +In view of this extraordinarily low mortality, it is interesting to +comment on human intellectual frailty. It was said that the hospitals +were septic, that operations of election could not be performed with +safety, that the climate was particularly dangerous, and so forth. One +letter which reached us made reference to hundreds of deaths of brave +fellows due to faulty camp and hospital conditions. Yet here is the fact +recorded that the total deaths in Cairo amongst Australians from disease +and wounds to August 14 were only 155. All men tend to generalise on +insufficient instances, and the tendency in this case was aggravated by +some physical discomfort experienced by the generalisers throughout an +unusually warm summer--a discomfort accentuated by overwork and a +conscientious devotion to duty under trying conditions. + + +THE EGYPTIAN CLIMATE AGAIN + +Dealing with the surgical side of the matter, nothing was commoner at +one time than to hear the statement made that owing to the hot weather +septic infections were common, that wounds did not heal as they should +in Egypt, and that it was not a suitable place to which wounded men +should be sent. While quite agreeing with the critics that a cool +climate is always preferable to a hot one, it may be remarked that in +the first place summer in Egypt, apart from the khamsin, is not +excessively hot. The khamsin blows for a certain number of days in +April, May, and the first half of June. The temperature may rise to 112° +or more. The wind blows with a fiery blast, and there is no doubt it is +exceedingly trying. But if buildings are shut up early in the morning +and opened at night, even the khamsin may be made tolerable. After the +middle of June, however, there is very little wind. One day is very +like another. The midday temperature is from 90° to 95° Dry Bulb, and +the nights perhaps 65° to 70° Dry Bulb. The Wet Bulb temperatures are +set out in the table previously referred to. + +For the most part men slept in nothing but pyjamas. No sheet is wanted +until towards the end of August. Whilst it is not pleasant to wake in +the mornings in a lather, nevertheless, if a practical and cold-blooded +examination be made of the facts, the result shows nothing but +discomfort. + +Grave septic diseases did not occur. The hospitals were perfectly clean, +and at Luna Park in particular we have the testimony of Colonel Ryan +that the wounds healed by first intention and that the cases did +excellently. + +As the garrison of Egypt was a very large one, and as Australian troops +were continually pouring into it, it was impracticable even if it had +been necessary to take the patients anywhere else. The islands of Lemnos +and Imbros were far less suitable even for those who had been injured at +Gallipoli, and apart from the inconvenience caused by the heat there was +no reasonable ground for complaint in Egypt. Furthermore the heat is not +tropical. It is subtropical, as the Wet Bulb temperatures indicate. + +In the First Australian General Hospital every care was taken to +minimise the inconvenience; a very large number of excellent ice chests +were purchased, an enormous quantity of ice was used, and the necessary +steps thus taken to diminish the amount of food decomposition and +prevent ptomaine poisoning. Fans and punkahs were used, and the nights +were quite tolerable. + + +MEDICAL ORGANISATION IN EGYPT + +When the Australian forces pass three miles from Australian shores they +cease, at all events technically, to be under Australian control, and +pass under the control of the Commander-in-Chief. On arrival in Egypt +they passed under the control of General Sir John Maxwell, +G.O.C.-in-Chief, Egypt. The medical section passed under the command of +the Director of Medical Services, Surgeon-General Ford. The D.M.S. +Australian Imperial Force, Surgeon-General Williams, arrived in Egypt in +February and was placed on the staff of General Ford to assist in +managing these units. He left for London on duty on April 25, and one of +us (J. W. B.) was appointed A.D.M.S. for the Australian Force in Egypt +on the staff of General Ford. Later, Colonel Manifold, I.M.S., was +appointed D.D.M.S. for Australian and other medical units. Thus the +Australian medical units were under the same command as New Zealand or +British units, but with separate intermediaries. + + +THE RISK OF CHOLERA + +In view of the risk of cholera, the following note by Dr. Armand Ruffer, +C.M.G., President of the Sanitary, Maritime and Quarantine Council of +Egypt, Alexandria, was issued and, later on, inoculation was practised +on an extensive scale. + + +DR. RUFFER'S VIEWS ON CHOLERA + +(Report begins) "The first point is that although, in many epidemics, +cholera has been a water-borne disease, yet a severe epidemic may occur +without any general infection of the water supply. This was clearly the +case in the last epidemic in Alexandria. Attention to the water supply, +therefore, may not altogether prevent an epidemic. The second point is +that the vibrio of cholera may be present in a virulent condition in +people showing no, or very slight symptoms of cholera, _e.g._ people +with slight diarrhoea, etc. + +The segregation of actual cases of cholera, therefore, is not likely to +be followed by any degree of success, because this measure would not +touch carriers or mild cases, unless orders were given to consider as +contacts all foreign foes, and all soldiers who have been in contact +with them. This is clearly impossible. + +There cannot be any reasonable doubt, therefore, that if the Turkish +army becomes infected with cholera, the British Army will undoubtedly +become infected also. + +Undoubtedly inoculation is the cheapest and quickest way of protection +of the troops, provided this process confers immunity against cholera. + +It is very difficult to estimate accurately the protection given by +inoculation against cholera. My impression from reading the literature +on the subject is that: (1) The inoculations must be done at least +twice. (2) The inoculations, if properly made, are harmless as a rule. +(3) The inoculations confer a certain protection against cholera. I may +add that I arrived at this opinion before the war, when the French +editors, Messrs. Masson & Co., asked me to write the article "Cholera" +for the French standard textbook on pathology. My opinion was therefore +quite unprejudiced by the present circumstances. + +The cholera inoculations were harmless _as a rule_; that is, _they were +not always harmless_. Savas has described certain cases of _fulminating +cholera_ amongst people inoculated _during the progress of an epidemic_. +In my opinion, the people so affected were in the period of incubation +when they were inoculated, and the operation gave an extra stimulus, so +to speak, to the dormant vibrio. One knows that, experimentally, a small +dose of toxin, given immediately after or before the inoculation of the +microorganism producing the toxin, renders this microorganism more +virulent. + +The conclusion to be drawn is that inoculations should be carried out +before cholera breaks out. + +I am afraid I know of no certain facts to guide me in estimating the +length of the period of immunity produced by inoculations. Judging by +analogy, I should say that it is certainly not less than six months, +that it, almost certainly, lasts for one year, and very probably lasts +far longer. + +I understand that 90,000 doses of cholera vaccine have been sent from +London. I take it that the inoculation material has been standardised +and its effects investigated, but, in any case, I consider that a few +_very carefully performed_ experiments should be undertaken at once in +Egypt, in order to make sure of the exact method of administration to be +adopted under present conditions. + +Probably, a good deal may be done by the timely exhibition of drugs, +such as phenacetin, etc., to mitigate the more or less unpleasant +effects of preventive inoculation. + +As I am on this subject, may I point out the necessity of establishing +at the front a laboratory for the early diagnosis of cholera and of +dysentery. Cholera has appeared in the last three wars in which Turkey +has been engaged, and therefore the chances of the peninsula of +Gallipoli becoming infected are great. The early diagnosis of cases of +cholera, especially when slight, is extremely difficult and often can be +settled by bacteriological examination only. + +There never has been a war without dysentery, and almost surely our +troops will be infected in time, if they are not already infected. But +whereas in previous wars the treatment of dysentery was not specific, +the physician is _now_ in possession of rapid methods of treatment, +provided he can tell what kind of dysentery (bacillary or amoebic or +mixed) he is dealing with. + +This differential diagnosis is a hopeless task unless controlled at +every step by microscopical and bacteriological examination. + +The French are keenly aware of this fact, so much so that they have +sent, for that very purpose, three skilled bacteriologists, two of whom +are former assistants at the Pasteur Institute, to the Gallipoli +Peninsula" (Report ends). + + +OTHER INFECTIOUS DISEASES + +The Infectious Diseases Hospitals were filled mostly with cases of +measles and its complications, including severe otitis media. Cases of +erysipelas, scarlatina, scabies, and diphtheria were met with in small +numbers. In the autumn there was a severe epidemic of mumps. + +Through the summer and autumn many cases of diarrhoea and of both +amoebic and bacillary dysentery made their appearance. There is good +ground for believing that many so-called diarrhoeal cases were +dysenteric. + +There is little doubt short of absolute scientific proof that the +greater part of the intestinal diseases are fly borne. + +The following table shows the admissions into the hospital, the deaths, +and causes of death, to July 31, 1915. + +A subsequent table shows the deaths and causes of death in No. 2 +Australian General Hospital from May 3 to August 18. + + + ADMISSIONS AND DEATHS INTO NO. 1 AUSTRALIAN GENERAL HOSPITAL + _From February to July inclusive_ + + ---------+-----------+-------------+----------------------------------- + |Admissions.| Deaths. | Cause of Death. + ---------+-----------+-------------+----------------------------------- + February | 1,360 | 1 | Malignant purpura + March | 1,791 | 12 | 6 Pneumonic group + | | | 3 Measles, etc. + | | | 1 Meningitis + | | | 1 Abscess, liver + | | | 1 Tumour, brain + April | 1,343 | 12 | 2 Pneumonic group + | | | 7 Measles, etc. + | | | 1 Meningitis + | | | 1 Septicæmia + | | | 1 Injury + May | 2,650 | 35 | 27 Wounds (1 tetanus) + | | | 1 Meningitis + | | | 1 Poliomyelitis + | | | 1 Cardiac + | | | 1 Pancreatitis + | | | 1 Appendicitis + | | | 3 Pneumonic group + June | 2,862 | 20 | 11 Wounds + | | | 1 Perinepritis + | | | 1 Nephritis, chronic + | | | 1 Septicæmia + | | | 1 Broncho-pneumonia endocarditis + | | | 1 Pneumonia + | | | 1 Meningitis + | | | 2 Enteric + | | | 1 Dysentery + July | 2,099 | 19 | 6 Wounds + | | | 1 Fracture, tibia + | | | 1 Enteric + | | | 6 Dysentery + | | | 1 Diphtheria + | | | 3 Meningitis + | | | 1 Enteritis + ---------+-----------+-------------+----------------------------------- + +In May and June 5,512 men were admitted, of whom 1,219 were Australians +and New Zealanders in camp, 2,967 Australians and New Zealanders from +the Mediterranean Expeditionary Force, 1,050 British, and 276 Naval +Division from the same force. + + +AUSTRALIAN IMPERIAL FORCE + + _Return showing Number of Deaths at No. 2 Australian General + Hospital, Ghezireh_ + _From May 3, 1915, to August 18, 1915_ + + AUSTRALIAN M.E.F. + Sickness 2 + Wounds in Action 9 + + BRITISH M.E.F. + Sickness nil + Wounds in Action 1 + + R.N.D. M.E.F. + Sickness 1 + Wounds in Action nil + + NEW ZEALAND M.E.F. + Sickness 1 + Wounds in Action nil + + AUSTRALIAN FORCE IN EGYPT + Sickness 1 + + D. MACKENZIE, _Captain_. + _Secretary and Registrar, No. 2 + General Hospital._ + + GHEZIREH, + _August 18, 1915_. + +This chapter would be incomplete unless proper acknowledgment were made +of the most valuable post mortem demonstrations given by Major Watson. + + + + + CHAPTER VIII + + VENEREAL DISEASES--THE GREATEST PROBLEM OF CAMP LIFE IN + EGYPT--CONDITIONS IN CAIRO--METHODS TAKEN TO LIMIT + INFECTION--MILITARY AND MEDICAL PRECAUTIONS--SOLDIERS' CLUBS. + + + + + CHAPTER VIII + + +The venereal-disease problem has given a great deal of trouble in Egypt +as elsewhere. The problem in Egypt does not differ materially from the +problem anywhere else, but a number of fine soldiers have been disabled +more or less permanently. + +When the First Australian Division landed in Egypt and camped at Mena, +the novelty of the surroundings and the lack of intuitive discipline +resulted in somewhat of an outbreak, both with regard to conduct and to +sexual matters. Both of these phases have been greatly exaggerated, but +nevertheless there was substantial ground for apprehension, and the +following letter from General Birdwood, Commander-in-Chief of the +Australian Army Corps, to the officers commanding units was sufficient +evidence of the necessity for action. + + "_For Private Circulation only_ + "DIVISIONAL HEADQUARTERS, MENA, + "_December 18, 1914_. + + +"The following letter written by Major-General W. R. Birdwood, C.B., +C.S.I., C.I.E., D.S.O., Commanding the Australian and New Zealand Army +Corps, to Major-General W. T. Bridges, C.M.G., Commanding the First +Australian Division, has been printed for private circulation. + + "V. C. M. SELLHEIM, + "_Colonel, A.A. and Q.M.G._" + + "HEADQUARTERS: AUSTRALIAN AND NEW ZEALAND ARMY CORPS, + "SHEPHEARD'S HOTEL, CAIRO, + "_December 27_, 1914. + +"MY DEAR GENERAL, + +"You will, I know, not misunderstand me if I write to you about the +behaviour of a very small proportion of our contingents in Cairo, as I +know well that not only you, but all your officers and non-commissioned +officers and nearly all the men must be of one mind in wishing only for +the good name of our contingents. + +"Sir John Maxwell had to write recently complaining of the drunkenness +of some of our men in the Cairo streets. During Christmas time some +small licence might perhaps have been anticipated, but that time is now +over, and I still hear of many cases of drunkenness, and this the men +must stop. + +"I advisedly say 'the men must stop,' because I feel it is up to the men +themselves to put a stop to it by their own good feeling. I wonder if +they fully realise that only a few days' sailing from us our +fellow-countrymen are fighting for their lives, and fighting as we have +never had to do before, simply because they know the very existence of +their country is at stake as the result of their efforts. + +"We have been given some breathing time here by Lord Kitchener for one +object, and one object only--to do our best to fit ourselves to join in +the struggle to the best advantage of our country. I honestly do not +think that _all_ of our men realise that this is the case. Cairo is full +of temptations, and a few of the men seem to think they have come here +for a huge picnic; they have money and wish to get rid of it. The worst +of it is that Cairo is full of some, probably, of the most unscrupulous +people in the world, who are only too anxious to do all they can to +entice our boys into the worst of places, and possibly drug them there, +only to turn them out again in a short time to bring disgrace on the +rest of us. + +"Surely the good feeling of the men as a whole must be sufficient to +stop this when they realise it. The breathing time we have left us is +but a short one and we want every single minute of it to try and make +ourselves efficient. We have to remember too that our Governments of the +Commonwealth and Dominion have sent us here at a great sacrifice to +themselves, and they fully rely on us upholding their good name, and +indeed doing much more than that, for I know they look to us to prove +that these two contingents contain the finest troops in the British +Empire (whose deeds are going down in history), whom they look forward +to welcome with all honours when we have done our share, and I hope even +more than our share, in ensuring victory over a people who would take +all we hold dear from us if we do not crush them now. + +"But there is no possibility whatever of our doing ourselves full +justice unless we are every one of us absolutely physically fit, and +this no man can possibly be if he allows his body to become sodden with +drink or rotten from women, and unless he is doing his best to keep +himself efficient he is swindling the Government which has sent him to +represent it and fight for it. From perhaps a selfish point of view, +too, but in the interests of our children and children's children, it is +as necessary to keep a 'clean Australia' as a 'White Australia.' + +"A very few men can take away our good name. Will you appeal to all to +realise what is before us, and from now onwards to keep before them one +thought and only one thought until this war is finished with +honour--that is, a fixed determination to think of nothing and to work +for nothing but their individual efficiency to meet the enemy. + +"If the men themselves will let any who do not stick to this know what +curs they think them in shirking the work for which it has been their +privilege to be selected, then, I know well, any backslidings will stop +at once--not from thoughts of punishments, but from good feeling, which +is what we want. + +"I have just been writing to Lord Kitchener telling him how intensely +proud and well-nigh overwhelmed I feel at finding myself in command of +such a magnificent body of men as we have here; no man could feel +otherwise. He will, I know, follow every movement of ours with unfailing +interest, and surely we will never risk disappointing him by allowing a +few of our men to give us a bad name. This applies equally to every one +of us, from General down to the last-joined Drummer. + +"Will you and your men see to it? + + "Yours very sincerely, + "W. R. BIRDWOOD." + +Those who possessed any experience of life could not but realise that +18,000 particularly vigorous fine men, brought up in a country where +discipline is conspicuous by its absence, and landed for the first time +in a semi-eastern city such as Cairo, were likely to behave in such a +manner that a small minority would get into trouble. Active steps were +taken to meet the difficulties, and to prevent recurrence of the +outbreaks when the Second Division and other reinforcements arrived. + +General Birdwood accordingly issued the following circular: + + +"WARNING TO SOLDIERS RESPECTING VENEREAL DISEASE + +"Venereal diseases are very prevalent in Egypt. They are already +responsible for a material lessening of the efficiency of the +Australasian Imperial Forces, since those who are severely infected are +no longer fit to serve. A considerable number of soldiers so infected +are now being returned to Australia invalided, and in disgrace. One +death from syphilis has already occurred. + +"Intercourse with public women is almost certain to be followed by +disaster. The soldier is therefore asked to consider the matter from +several points of view. In the first place if he is infected he will not +be efficient and he may be discharged. But the evil does not cease even +with the termination of his military career, for he is liable to infect +his future wife and children. + +"Soldiers are also urged to abstain from the consumption of any native +alcoholic beverage offered to them for sale. + +"These beverages are nearly always adulterated, and it is said that the +mixture offered for sale is often composed of pure alcohol and other +ingredients, including urine, and certainly produces serious +consequences to those who consume it. As these drinks are drugged, a +very small amount is sufficient to make a man absolutely irresponsible +for his actions. + +"The General Commanding the Australasian Forces, therefore, asks each +soldier to realise that on him rests the reputation of the Australasian +Force, and he is urged at all costs and hazards to avoid the risk of +contracting venereal disease or disgracing himself by drink." + + * * * * * + +This leaflet was entrusted to Lieut.-Col. Barrett to deliver to troops +on arrival, and he accordingly visited Port Said and Suez, interviewed +the officers on the transports, and fully explained the position to +them. They were requested to use their influence with the men in the +direction of restraint. Subsequently after the destruction of the +_Konigsberg_ the transports began to arrive at irregular intervals and +it became impossible to meet the officers at the ports. They were then +interviewed at Abbassia or Heliopolis, and later still by order of +General Spens, G.O.C. Training Depot, the men themselves were +addressed on the day of their arrival. The form of address was simple. +The dangers of infection were pointed out to them--particularly as +regards typhoid fever, dysentery, bilharzia, and venereal disease. They +were shown how the first three diseases could be avoided. So far as +venereal disease was concerned they were informed that the matter was in +their own hands. They were asked to imitate the Japanese, and by their +own efforts preserve their health with the same care that they bestowed +on their rifles or their ammunition, the preservation of health and arms +being equally important. Passages from the famous rescript of the +Emperor of Japan before the Russian war were quoted in which it was +stated in substance that if the normal proportion of sick existed in the +Japanese army defeat was a practical certainty; but that if they +followed the direction of their medical officers and took the same care +of their bodies as they took of their equipment, the number of troops +saved thereby would make all the difference in the ensuing conflict. + +[Illustration: VENEREAL DISEASES HOSPITAL, ABBASSIA. +_To face page 120_]] + +General Birdwood asked for the whole-hearted and enthusiastic +co-operation of all officers in doing their best to control their men, +and to prevent them from exposing themselves to the risk of venereal +disease. Some little time before the issue of the circular 3 per cent. +of the Force were affected by venereal disease on any one day. +Fortunately, as a result of the efforts made, the tendency was to +diminution, but the amount of venereal disease was still sufficiently +great to give concern and anxiety. + +There is no doubt that the action of General Birdwood prevented +outbreaks and limited the amount of disease. It is also equally true +that in spite of his efforts the amount of disease was too large to be +contemplated with equanimity. + +The Venereal Diseases Hospital, Abbassia, was nearly always full, but +from time to time drafts of men were sent back to Australia. One draft +of 450 soldiers was sent to Malta early in the campaign. The principle +involved in the policy of returning them to Australia was as follows. In +Egypt they were useless as soldiers, whether suffering from gonorrhoea +or syphilis. They required a large number of medical men and attendants +to take care of them. They knew they had disgraced themselves and were a +source of trouble to every one concerned. On shipboard they could not +get into trouble. They were more likely to be cured, and could then be +returned to Egypt, and if not cured could be treated in Australia at +leisure. Against this policy the argument was used that diseases were +being introduced into Australia, but as a matter of fact a minority of +the men suffering from venereal disease brought it from Australia to +Egypt. They arrived at Suez suffering from gonorrhoea contracted in some +cases at Fremantle. Furthermore the business of those conducting the +campaign was to wage a successful war, and to keep the base as free from +encumbrance as possible. The total number returned to Australia in this +way was as follows: + +From February to September 14, 1,344, and in addition 450 were sent to +Malta. + +At first they were sent in ships with other cases and sometimes +segregated on board, but difficulties arose at the Australian ports. The +people who welcomed the returned soldiers were sometimes enthusiastic in +greeting venereal cases by mistake, and sometimes non-venereal cases +were regarded with suspicion because they came from a ship known to +convey venereal patients. It was finally decided by the Australian +Government that venereal cases should be conveyed in ships by +themselves, the first consignment of 369 being sent in the _Port +Lincoln_. + +A certain number of the gonorrhoeal cases recovered and became fit for +service, but too often they relapsed. + +The authorities were fully alive to the damage which was being done, and +persistent and earnest attempts were made to deal with it from many +different points of view. General Maxwell issued an order prohibiting +the sale of drink after an early hour (10 p.m.) in the evening, and also +prohibiting soldiers from being found in Cairo after an early hour. +There is no doubt that both of these directions proved to be of +considerable value. + + +MORAL CONDITIONS IN CAIRO + +Something must be said, however, about the moral conditions in Cairo, +about which exaggerated and perverse notions seem to be entertained. +Cairo, like all large cities in the world, possesses its quota of +prostitutes, who differ only from prostitutes elsewhere in that the +quarters are dirtier and that the women are practically of all +nationalities, except English. The quarter in which they live is +evil-smelling, and is provided with narrow streets and objectionable +places of entertainment. It contains a considerable infusion of Eastern +musicians and the like, and is plentifully supplied with pimps of the +worst class. These men were promptly dealt with by the police, the +authorities giving the most sympathetic assistance to the military. + +As in other countries, there were graduations in the class of women +employed, and the personal impression gained by the authorities was that +the danger of infection was greatest from those at the top and the +bottom of the social scale. Prostitutes who were registered were +examined by a New Zealand gynecologist, who did the work very +thoroughly, and conscientiously, and with kindness. Women who were free +from disease were furnished with a ticket indicating that they were +healthy. At the beginning of the war there were 800 of these women in +Cairo, but as the war progressed the number grew to 1,600. The +arrangement then differed in no way from the arrangements in Melbourne +or Sydney except that the surveillance of the police was direct, and +medical examination was insisted upon. It further had this advantage +over those of Melbourne and Sydney, that the women were confined to one +particular part of the city, and no one need come in contact with them +unless they wanted to. Consequently for those who went to this quarter +there is no excuse, since they acted deliberately. + + +PROPHYLAXIS + +At the same time, when all these measures were weighed in the +balance--plain speaking to the men on arrival, police surveillance, +medical examination, etc.--it was felt that more might be done. A number +of medical officers accordingly gave instruction to their men in the +means of effecting prophylaxis and of preventing infection in the event +of association with these women. The medical officers acted entirely on +their own responsibility. They advised the men to avoid the risk, but as +they knew a certain number would not take their advice in any +circumstances--in fact the men said as much--they showed them how to +avoid infection if they would take the necessary trouble. + + +RESULT OF PROPHYLAXIS + +In the case of our own unit, the First Australian General Hospital, +trouble was taken to explain in detail the consequences of venereal +diseases to the men, and to those with whom they would be associated in +later life. They were asked to refrain from taking the risk, but for +those who would not take the advice--and there was bound to be a +percentage--the necessary directions and material were provided for +preventing infection. The result was challenged by a medical officer, +and an immediate examination of all the men made, when it was found that +in the whole of the unit only one man was infected. In other words, the +precautions taken had practically stamped the disease out of the unit, +and shortly after arrival in Cairo. + +Once the disease was acquired the treatment was troublesome to a degree. +The men knew they were disgraced; they would probably be sent back to +Australia; and in some cases, those of the finer men, the consequences +were serious. Mostly, however, they developed an attitude of sullenness +and indifference, a tendency to lack of discipline, and they rendered +the management of camps difficult. These troubles to a large extent +disappeared when a suitable hospital was established. + + +SOLDIERS' CLUBS + +But another and constructive side of the matter appealed forcibly to +those concerned. Why not supply for the benefit of the men places of +entertainment with music, refreshments, and the like, similar to and +better than those which the prostitutes supplied, but minus the +prostitute. In other words, why not give a healthy and reasonable +alternative? After consultation with His Excellency Sir Henry MacMahon, +with the G.O.C.-in-Chief, General Sir John Maxwell, and with the D.M.S. +Egypt, General Ford, the Australian Red Cross Society determined to +combine with the Y.M.C.A. and establish clubs for the soldiers in +central positions where these requirements would be met. They +accordingly established a club at the quay in Alexandria, and a +magnificent open-air club in the Esbekieh Gardens, Cairo. They were both +immediately successful, and have played a most important part in the +further limitation of the amount of venereal disease. It is difficult to +give statistical evidence, but there is no doubt that by these various +means a sensible difference has been produced in the incidence of +disease amongst the troops. + + +THE DUTY OF THE MEDICAL OFFICER + +We have never wavered from the conviction that any one suffering from +venereal disease should be treated by a medical practitioner exactly +like any other sick person. In military service, however, an added +element makes its appearance in that the soldier by his act has rendered +himself unfit, and consequently must suffer some pains and penalties. It +is no answer to say that other men have exposed themselves and have not +become infected. The fact remains that he has by a deliberate and +avoidable act deprived his country of the value of his services. And +whilst the doctrine of punishment should not be pushed too far, he +certainly should not receive the same general treatment as other +soldiers, and the policy of his prompt return to Australia and +deprivation of pay was in the circumstances the best one. + +In the Venereal Diseases Hospital, Abbassia, the men were well treated. +They were well fed, and a certain amount of Red Cross help was given to +them. + +Many proposals were made which were not carried into effect: for +example, placing of the prostitute quarter "out of bounds" and the +posting of sentries. It was realised that the immediate effect of this +action would have been to drive women to the vicinity of the camps, and +that it was impracticable. Another practicable proposal was made, which, +however, was not carried into effect--the creation of dispensaries in +the vicinity of the prostitute quarter, so that immediate treatment +could be obtained. In many camps such dispensaries were established by +the medical officers. + +The essence of the problem was learnt by a Brigadier-General who visited +a number of young educated men in one of the camps, and asked them for +their viewpoint on the subject. Their answer was that which every +medical officer knows full well: that many men were influenced by the +appeals which had been made to them, but that a percentage have indulged +in this way throughout their adult life, and intend to continue to do so +irrespective of anything medical officers, chaplains, or generals may +say to them. It is this fundamental position which every reformer must +face. So long as a sufficient number of men determine to adopt this +policy, and so long as there is a sufficient number of women prepared to +cater for them, the problem of venereal disease will continue to be +acute in every country. + +The opinion has been expressed elsewhere that the world will not be +rendered more or less moral by the abolition of venereal disease, and +instruction in the mode of preventing infection should be an essential +part of education. Because people are immoral there is no reason why +they should acquire gonorrhoea or syphilis. If the _lex talionis_ is to +be enforced, the logical way to deal with the matter is to refuse +treatment to all the infected, and to let them die or become disabled. +But the most thorough-going Puritan shrinks from adopting so terrible a +policy. One method or the other, however, must be adopted--there can be +no half-way house. And if the decision be in favour of eradicating the +disease, it is essential to firmly face and grapple with the problem. + + +WASSERMANN TESTS + +The examination of the cases showed that gonorrhoea was far more common +than syphilis, and a series of Wassermann determinations showed that the +cases of soft sores did not give a syphilitic reaction in the early +stages. Captain Watson of the First General Hospital made a number of +determinations in order to try to settle this important point. + + +THE POLICY TO BE ADOPTED + +In spite of all that was done, 1,344 men were returned to Australia +disabled, and 450 were sent to Malta. If a calculation be made of the +cost of sending these men to Egypt and back, and of their pay before +they were infected, some idea may be formed of the enormous sum of money +the Australian Commonwealth wasted on men who were a drag and hindrance +to the army machine. + +The Government should, on the raising and equipping of a volunteer +army, treat it as older countries treat a standing army by issuing +instructions to the men. + +When the Hospitals left Australia neither officers nor men received +instructions, and not until the arrival of Surgeon-General Williams in +Egypt was any serious collective action taken. He at once called a +conference of medical officers and did what he could to limit the extent +of disease. + +The governmental action--or lack of action--is unsound, since the man +who contracts disease is severely punished, but adequate attempts are +not made to prevent him acquiring it. The notable departure made in the +case of Cairo was the effort to make the men understand clearly what +these diseases meant to them as soldiers and as citizens; to remove +temptation from them as far as possible, and with the aid of the +Australian Red Cross to give them a reasonable, healthy, and decent +alternative. Nothing the Australian Red Cross has done (or is likely to +do) is more important than the establishment of the Soldiers' Clubs. +Nothing has been more successful or is likely so to redound to the +credit of that great institution. And yet, under the new Constitution of +the Australian Red Cross, not a shilling can be devoted in the future to +such purposes. + + +VENEREAL DISEASES CONFERENCE + +The following are brief notes of a Conference of senior medical officers +convened by Surgeon-General Williams. + +Reference was made to the gravity of the problem with which the force +was faced. It was estimated that about 1,000 men of the First and Second +Australian Divisions are suffering from venereal disease on any one day, +and of these a large number are incapacitated from work. The proportions +seemed to be much greater than those of other forces, such as the +Territorials, in Egypt. The displacement of so large a proportion of men +and the ultimate consequence of numerous infections, rendered it +necessary to take a comprehensive view of the position, and to endeavour +to take some action to minimise the damage done. It was proposed to ask +each officer present to furnish the secretary with a general statement +of the number of cases treated under their command, specifying them +under three headings--syphilis, soft chancre, and gonorrhoea. The +information so obtained would form the basis of a report to +headquarters. The problem was considered under five headings: + +1. Military assistance. + +2. Use of prophylaxis. + +3. Treatment--general and special. + +4. Establishment of convalescent depots--accommodation and position. + +5. Ultimate destination of affected men. + +1. _In what way can the military authorities give assistance?_--There +are three ways in which they can approach the problem: + + (_a_) They may decide that all areas known to contain brothels + are out of bounds. + + (_b_) They can provide adequate military control by military + police organised under a competent officer, with one or more + junior medical officers to assist him. + + (_c_) That punishment can be inflicted on those men who break + bounds and expose themselves to the risk of venereal infection. + It might be desirable to reduce the pay of men found in those + areas whether suffering from venereal disease or not. + +2. _Prophylaxis._--Officers were invited to discuss the question whether +it would not be advisable to establish prophylactic depots in various +parts of Cairo. Men to report immediately after exposing themselves to +infection, and by cleanliness and the use of medicaments prevent +infection. Circulars couched in plain and sensible language might be +issued to the troops, conveying to them a knowledge of the risk they +run, and the fact that if infected they will take back to Australia a +disease which would reduce their value as citizens. + +3. _General and Special Treatment._--Suggestions from officers present +were invited. + +4. _Convalescent Depots._--Was it right that the hospital should be +crowded out with venereal cases, which demanded very much time and +attention from the staffs? If the hospital was placed near the scene of +military action the wounded might suffer from the amount of attention +required for venereal cases. Most venereal cases required rest in the +main, and this could be obtained in convalescent depots. + +5. _The ultimate destination of the affected men._--Two courses are +open: The men may be treated in Egypt, or sent back to Australia. + + (_a_) If they are kept in Egypt and the Australian Expeditionary + Force is moved to the front its medical services would be + depleted, and medical men of great ability and experience would + be left behind to take charge of venereal cases when their + services were required at the front. + + (_b_) If on the other hand the Australian and Imperial + Government could utilise some ships for the accommodation of + these men, those who were cured could be sent to the front, and + those who could not be cured could be sent back to Australia at + once. But such ships would require special staffing so that the + existing units should not be depleted in order to provide + staffs. + +In the discussion which ensued it was represented that there was a +difficulty in placing areas out of bounds, as the brothels would be +moved to other areas. Prophylaxis was regarded as most important. +Isolation tents could be set apart in the regimental lines where men +could be treated on return from leave. Cases of syphilis should be sent +to Australia. + +The reduction of pay is forbidden by King's Regulations, and although +the Minister for Defence in the Commonwealth of Australia authorised +such reduction, it is only for such period as the troops are in Egypt. + +It was agreed that cases of syphilis should be returned to Australia, as +there is no chance in Egypt of treating them efficiently, and even if +such treatment were available the men would not be fit for duty for from +four to six months. + +It was pointed out that at least 100 men left Australia with the First +Division suffering from venereal disease. + +[Illustration: SOLDIERS' CLUB, ESBEKIEH, CAIRO. +_To face page 133_]] + +The chief difficulty seemed to be what venereal cases would ultimately +be of service to a fighting line, and to properly arrange for them +during convalescence; in other words, when and how men considered unfit +for further service should be returned to Australia. Officers were asked +to recollect that the future of these soldiers was to be considered and +the part they would play in civil life. In the American Navy unbounded +shore leave had been given, and had some effect in checking the disease. +In the British Navy it was an offence not to report "exposure." + + * * * * * + +The Soldiers' Clubs are fully described in the chapter on the Red Cross. +They were rendered possible by an alliance between the Y.M.C.A. and the +Australian Branch British Red Cross. To the Y.M.C.A., who managed them, +the best thanks of Australia should be given, for Australians will never +fully know what they owe to Mr. Jessop and his assistants. +Unfortunately, the Australian Branch British Red Cross subsequently +decided that help should be given _only_ to sick and wounded. Although +convalescents frequent these clubs, the view was taken--we think +wrongly--that Red Cross funds could not be used for their support. We +feel sure that when Australians fully understand the matter the decision +will be reversed. + + + + + CHAPTER IX + + THE RED CROSS WORK: ITS VALUE AND LIMITATIONS--ORIGIN IN + AUSTRALIA--REPORT OF EXECUTIVE OFFICER IN EGYPT--RED CROSS + POLICY--DEFECTS OF CIVIL AND THE ADVANTAGES OF MILITARY + ADMINISTRATION--WHAT WAS ACTUALLY DONE IN EGYPT. + + + + + CHAPTER IX + + +The British Red Cross Society, Australian Branch, was founded by Her +Excellency Lady Helen Munro Ferguson, wife of the Governor-General of +Australia, on the outbreak of war. On previous occasions unsuccessful +attempts had been made to found an Australian Red Cross Society. On this +occasion the movement was most successful, although many people then +(like some people now) were quite unable to understand the distinction +between the Red Cross movement and military administration. + +The Red Cross Society in Australia undertook the collection of funds for +immediate transmission to the British Red Cross Society for prompt use +in the field. Branches were formed in each State and committees were +formed by the wives of the various governors. Thus a rough-and-ready +arrangement was made prior to the adoption of a constitution. It was +considered far more important to do the work than to waste time holding +meetings and devising a constitution. Those who could not afford to give +money were invited to make clothing or to contribute articles of various +kinds. Specifications of the clothing requisite were given, and patterns +furnished so that it might be readily made on approved design. It is not +too much to say that the majority of the inhabitants of the Continent +were soon engaged in some way or other in helping the Red Cross +movement. The ball-rooms of the respective Government Houses were used +as depots. The depot at Federal Government House, Melbourne, was an +excellent model. People were invited to send their donations +irrespective of their number or their kind. These were received and +receipted, and were then sorted into bundles of similar articles by lady +volunteers. They were then placed in cases by volunteer packers, mostly +experienced men from various warehouses, and were finally dispatched to +Europe as opportunity offered. + +The arrangement of these details fell largely on the Council and +Secretary of the Branch (one of us, J. W. B.) in Australia acting under +the direction of the President, Her Excellency Lady Helen Munro +Ferguson. Very great difficulty was experienced in finding space in +merchant ships for the conveyance of the goods. Space was found on the +transports, but there was not the same security for delivery. In +addition the hospitals of the transports were provided with such +equipment as the officers commanding desired. + +When, however, the Lines of Communication Units were ordered to Egypt, +another problem arose, and the Australian Red Cross Society decided to +properly equip these units both with money and goods. For this purpose +£10,000 was set aside and forwarded to London. It was handed to the +British Red Cross Society and kept available for the officers commanding +the five hospitals, the requisite sum of money to be allotted to them by +Surgeon-General Williams, C.B., the Director of Medical Services in +Australia, who had proceeded to Europe. At the time it was supposed that +these five hospitals were proceeding to France. In addition large +quantities of goods were available at the British Red Cross Society in +London, and large quantities of goods were given to the several +hospitals for dispatch with their equipment. When, however, the +hospitals were sent to Egypt a new situation arose. There were many +other medical units in Egypt besides the hospitals. There were the Field +Ambulances and the Regimental Medical Officers, and Surgeon-General +Williams regarded them as equally worthy of assistance. On his arrival +in Egypt at first, in December, and subsequently in the middle of +February, the scope of the British Red Cross, Australian Branch, in +relation to Australian troops had extended far beyond the original +intention. The action taken is described in the following report sent to +the President and members of the Council, British Red Cross Society, +Australian Branch, on my resignation (Lieut.-Col. Barrett) from that +body on September 9, 1915. I did not at any time receive any +instructions from Australia, and acted in the manner which seemed best +after consultation with local authorities. + + + REPORT ON THE WORK OF THE AUSTRALIAN BRANCH BRITISH RED CROSS IN + EGYPT, FROM MARCH TO SEPTEMBER 3, 1915 + + _By_ JAMES W. BARRETT, _Lieut.-Colonel, Lately Executive + Officer, Australian Branch British Red Cross Society_ + + REPORT PRESENTED TO THE PRESIDENT AND MEMBERS OF THE COUNCIL OF + THE AUSTRALIAN BRANCH BRITISH RED CROSS SOCIETY + +The First Australian General Hospital arrived in Egypt in January 1915. +I was associated with it as Registrar and Oculist and had nothing to do +with the Red Cross movement beyond assuming responsibility for any Red +Cross goods which belonged to the Hospital. + +When leaving Melbourne Colonel Ramsay Smith was informed that there +would be room for 100 tons of Red Cross goods in the _Kyarra_. When, +however, the _Kyarra_ reached Melbourne her holds were full and no Red +Cross goods were taken on board. There were consequently not any Red +Cross goods available at No. 1 Australian General Hospital for some +considerable time after arrival in Egypt. + +Surgeon-General Williams, C.B., arrived in Egypt in the middle of +February, and at once proceeded to organise the Red Cross movement. He +had been entrusted with £10,000 which was to be expended by the officers +commanding medical units according to the plan set out later. He at once +took action, and money was distributed to a number of hospitals and +medical units. This distribution was of the utmost service. + +[Illustration: HELIOPOLIS PALACE HOTEL. +_To face page 141_]] + +When Red Cross goods began to arrive in Egypt he sought a suitable +store. Finding nothing in Cairo at a reasonable price, he established a +store in the basement of the Heliopolis Palace Hotel, No. 1 Australian +General Hospital, for which, of course, no rental was charged. The store +was placed under the immediate charge of the Orderly Medical Officer, +Captain Max Yuille, and under my general direction. The distribution of +money and collection of goods from ships was effected by General +Williams through his own office in Cairo. + +General Williams left for London on duty on April 25, leaving me in +charge of the Red Cross work, and leaving his Warrant Officer, Mr. +Drummond, in his office to continue the collection of goods and the +clerical work. + +Soon after he had left, the crisis of May and June took place. Wounded +and sick were poured into Cairo on a scale probably never known or +equalled before. There have been occasions on which a much larger number +of men have been wounded, but probably never any occasion in history in +which so many wounded men have been handled in so limited a space. +Fortunately preparation had been made by the D.M.S. Egypt, +Surgeon-General Ford, D.S.O., and the D.M.S. A.I.F., Surgeon-General +Williams, C.B., who instructed the O.C. First Australian General +Hospital, Colonel Ramsay Smith, and myself as registrar to take over +extra buildings and provide equipment. It was this action which +prevented a disaster, and whilst not strictly a Red Cross matter was +greatly aided by Red Cross equipment. + +During this crisis I was instructed by the D.M.S. Egypt, Surgeon-General +Ford, and the O.C. Australian Intermediate Base, Colonel Sellheim, to +visit various hospitals in Egypt--both in Alexandria and the +provinces--to interview the Australian wounded and supply all reasonable +comforts. In accordance with this order, money and goods, either or +both, were sent to various hospitals as set out in the various tables. + +It so happened that the British Red Cross Society possessed neither +money nor goods at the inception of the crisis, and the authorities were +profoundly grateful for the help which the Australian Branch afforded. +The British Red Cross, Egyptian Branch, at a later stage received large +supplies of money and goods which were freely distributed. The fact that +goods could be obtained from the British Red Cross Society, Australian +Branch, soon became known, and many requisitions were received. The list +of goods available was widely circulated and in no instance was the +requisition of any Officer Commanding not complied with. It was always +completed to the extent of our resources. Periodical reports of the work +done were prepared and forwarded to the President of the Australian +Branch British Red Cross Society, Melbourne. + +Whilst the work was at its height a message from Australia reached His +Excellency Sir Henry MacMahon, in consequence of which two Committees +were formed on June 3, 1915--a General Egyptian Committee and an +Executive Committee. + +The members were: + + { President, His Excellency Sir Henry MacMahon. + General { Lord Edward Cecil. + Committee { Sir Alexander Baird. + { Sir Courtauld Thomson. + + { Sir John Rogers. + Executive { Dr. Ruffer. + Committee { Surgeon-General Williams. + { Lieut.-Colonel Barrett. + +Sir Courtauld Thomson is the Commissioner in the Mediterranean for the +British Red Cross Society, and Sir John Rogers and Dr. Ruffer Deputy +Commissioners in Egypt. + +Surgeon-General Williams and Lieut.-Col. Barrett were appointed members +of the Executive Committee of the British Red Cross Society in Egypt. + +There was no amalgamation of the two branches, but by this arrangement +each was kept informed of the activity of the other and wasteful +overlapping was avoided. + +Members of the General Committee investigated the work of the Australian +Branch, were consulted in matters of policy, and received and +investigated any complaints. They were most helpful. + +General Williams returned to Egypt on June 21, made a tour of +inspection, and visited the Australian wounded. He reported to the +Government, and finally left for London on duty on June 29. On this +occasion he took with him his office staff, and consequently the +administration fell largely into my hands. + +On July 13, however, I learned by cable from Australia that two +Commissioners had been appointed in terms which seemed to place them in +entire control of the Red Cross movement. + +As it was desirable that other medical officers should be associated +with the movement. Colonel Ryan, Colonel Martin, and Lieut.-Col. +Springthorpe were invited by His Excellency Sir Henry MacMahon to join +the Executive Committee. + +Mr. Adrian Knox, K. C., the first of the Commissioners, arrived in Cairo +on August 11, and the second Commissioner, Mr. Brookes, reported on +August 27. I endeavoured to help them in every way that was possible, +and finally asked to be relieved of the work on September 9, expressing +my willingness, however, to continue to aid in any way they desired. My +relationship to them has been cordial, and I am very glad if I have been +able to be of any assistance. + +I now propose to deal with the operations of the Society under various +headings: + +1. _Finance._--The original fund in the hands of Surgeon-General +Williams was operated upon by him in London, in Malta, and in Egypt. It +was only in Egypt that I was concerned with it, and to a limited extent. +It was most helpful, and great service was rendered during the crisis by +the prompt distribution of money. + +When the General Committee, of which His Excellency Sir Henry MacMahon +is President, was formed, separate funds were forwarded to him in +response to a cable from me indicating that more money was wanted. I +suggested the supply of another £10,000, but when, on July 9, £18,000 +had been received it became obvious that operations were contemplated on +a more extensive scale than had hitherto been thought necessary. I have +prepared a summary of the amounts distributed to medical units from both +funds, and given an account of the method adopted. + +The Red Cross Society originally intended that £10,000 was to be +expended by the officers commanding medical units, and General Williams +embodied the direction in the following circular, to which I +subsequently added a memorandum in further explanation of new conditions +which had arisen. + +[Illustration: INTERIOR OF RED CROSS STORE: UTILISATION OF CASES FOR +SHELVING. +_To face page_ 144]] + + _Australian Imperial Force_ + +Received from Surgeon-General W. D. C. Williams, Director Medical +Service, A.I.F., the sum of ---------------- stg. to be utilised and +accounted for by me in terms of Circular Letter No. E 1/15, dated +13-2-15. + + ---------------- O.C. + _Place_ ---------------- + _Date_ ---------------- + + + _Australian Imperial Force_ + + Circular Letter No. E 1/15. + O.C., + +1. Forwarded herewith the sum of ---------------- stg. to be expended by +your authority and direction on such articles as you may consider +requisite for the general improvement of equipment, stores, or other +items which in your opinion will conduce to the general well-being and +comfort of the patients in hospital under your command. + +2. Attached receipt forms to be signed in duplicate and returned to me. + +3. When three-fourths of the amount allocated to you has been expended, +you will furnish this office with expenditure vouchers in duplicate. +This will enable me to keep the High Commissioner informed as to how the +moneys are being spent, and to arrange for further grants if considered +necessary. + + SURGEON-GENERAL, + _Director Medical Services, A.I.F._ + + + [_Copy_] + _May 20, 1915._ + + O.C. + Govt. Hospt. + Tanta, Damanhour and Shebin el Kom. + +1. I enclose herewith cheque for {£50 £25 £25} to be expended in terms +of the Circular Letter attached. Will you please sign the accompanying +receipt in duplicate and oblige. + +2. It is not desired that the expenditure of the money should be +restricted to Australians, as such a course would, I think, in a +hospital be impracticable and undesirable. If, however, this is used for +all the Allied troops under your care, then the next instalment which +may become necessary might well be provided from the "Military Hospitals +Fund" or the "Egyptian Red Cross Fund." + +3. I shall be glad if you will communicate to the men in the Hospital +the fact that comforts are being supplied from the Fund of the British +Red Cross Society (Australian Branch), the administration of which fund +is in the hands of Surgeon-General W. D. C. Williams, C.B. + + (_Signed_) + JAMES W. BARRETT, + _Major_, + for W. D. C. WILLIAMS, + _Surgeon-General_. + + +GRANTS OF MONEY MADE TO VARIOUS HOSPITALS FROM RED CROSS FUNDS + + Hospital or Medical Unit, etc. Amount in + Egyptian + pounds. + First Australian General Hospital and + Auxiliaries 1376,42.5 + Second Australian General Hospital 682,50 + Share of Rent of Luna Park for three + months 117,00 + Y.M.C.A. (including stationery, building + fund, Soldiers' Café, and sundry accounts) 982,08.6 + Venereal Hospital, Abbassia 48,75 + Deaconess Hospital, Alexandria 78,00 + European Hospital, Alexandria 48,75 + Government Hospital, Tanta 53,62.5 + No. 21 General Hospital, Alexandria 97,50 + Convalescent Home, Al Hayat, Helouan 341,25 + Convalescent Home, Ras el Tin, Alexandria 97,50 + A.D.M.S., First Australian Division 292,50 + First Stationary Hospital 195,00 + Second Australian Stationary Hospital 196,24.7 + First Casualty Clearing Station 146,25 + Fourth Field Ambulance 290,00.2 + First Light Horse Field Ambulance 97,50 + Second Light Horse Field Ambulance 195,00 + Third Light Horse Field Ambulance 48,75 + Fifth General Hospital 97,50 + Fifteenth Stationary Hospital 97,50 + 17th General Hospital 146,25 + Bombay Presidency Hospital 58,50 + Government Hospital, Alexandria 48,75 + Convalescent Camp, Mustapha 48,75 + Government Hospital, Damanhour 24,37.5 + Government Hospital, Shebin el Kom 34,12.5 + 5th Indian General Hospital, Alexandria 48,75 + Government Hospital, Benha 5,00 + Greek Hospital, Alexandria 29,25 + Government Hospital, Suez 24,37.5 + Red Cross Depot, Suez 48,75 + Ras el Tin Hospital, Alexandria 195,00 + 15th General Hospital, Alexandria 48,75 + ---------- + £E.6340,26 + +The Egyptian pound is to the British pound sterling as 100:97·5. + +In addition, a considerable amount of money had been spent in other +countries. There was, however, no knowledge in Egypt of the sum which +would be ultimately available. Furthermore, in the absence of +instructions from Australia, no serious departure had been made from the +policy originally laid down. In fact I am doubtful to a degree whether +any Red Cross movement should in normal conditions go beyond the +successful policy adopted. + +2. _Red Cross Store._--Goods received were passed into the Red Cross +store, the contents of the cases ascertained as far as possible, and +entered in books kept for that purpose. They were issued on requisition +signed by the Officer Commanding any medical unit. Corresponding entry +was made in the book of issue, and the difference between the stock +received and that issued from day to day was shown in the form of a +stock sheet. Stock-taking was effected from time to time. + +[Illustration: RED CROSS BASE DEPOT, HELIOPOLIS. +_To face page 148_]] + +The store was staffed at first by two nurses and three orderlies, later +it was staffed by a sergeant and six or seven orderlies who were +approved by the military authorities. The staff therefore consisted of +myself, with my own clerical staff, the orderly officer of the hospital, +Captain Max Yuille (latterly Captain Dunn), the sergeant and seven +orderlies, together with extra helpers at times. The store was connected +by telephone with the hospital, and every effort made, compatible with +the excessive demands on the time of all, to manage it in a methodical +manner. + +3. _Receipt of Goods._--The receipt of goods has, owing to the +peculiarities of Egypt and the circumstances of the war, given a good +deal of trouble, and I am making it the subject of a separate +memorandum. It may suffice here to say that it will never be +satisfactory until the Red Cross Society in Australia cables, when the +ship leaves Fremantle, precisely the number of packages on board, the +port of destination, and the probable time of arrival of the ship; and +also accurately informs the officers commanding the ship of the nature +of the Red Cross goods on board. In this connection it may be +interesting to note the following letter from Colonel Onslow, who has +just arrived by the _Runic_ in Egypt, and who, but for the printed +instructions drawn up by me and conveyed to him at Suez, would not have +known that any Red Cross goods were on board: + + CONTINENTAL HOTEL, CAIRO, + _September 13, 1915_. + + LIEUT.-COLONEL BARRETT, + A.A.M.C. + + MY DEAR SIR, + +You will remember that on Saturday last you asked me to write to you +regarding the Red Cross Stores on the Transport A 54 _Runic_ of which I +was in military command. + +When I took command on August 9 in Sydney I had no information as to +there being any Red Cross Stores on board except that one of the ladies +of the Red Cross Committee had told me that a few stores were to be put +on board and would be at my disposal if needed for the troops under my +command. + +Subsequently I saw some half a dozen cases which I assumed to be those +to which she had alluded. + +On arrival at Suez, September 9, the printed instructions as to disposal +of Red Cross Stores were handed to me. This caused me to make inquiries. +The ship's purser knew nothing of any such stores and they were not +shown in the manifest. + +But from the Chief Officer I learned that a large number of which he had +an incomplete list had been placed in one of the holds. It was even then +too late for me to ascertain their number or nature, as I was in the +midst of disembarking returning ship stores, etc. They were therefore +landed without the required list. + +But if either a wireless had been sent to me a day or two beforehand, or +if the persons responsible for shipping had informed me in Sydney, there +would have been no difficulty whatever. Under the lack of system which +would seem to prevail in shipping these stores from Australia it would +not be surprising if they were overcarried and lost. + + Yours faithfully, + (_Signed_) J. MACARTHUR ONSLOW, + _Colonel_. + +I publish this letter simply to show the difficulties and to indicate +the magnitude of the task. I do not think any one is to blame, but +rectification is wanted. A huge commercial concern has gradually grown +up and now requires firm paid commercial management. The Australian Red +Cross has become a gigantic Commercial Institution with attendant +advantages and disadvantages. + +It should be remembered that goods are shipped in Australia from at +least six different ports separated by distances of hundreds of miles, +that nearly the whole of the work has been amateur, and that it is +difficult to inaugurate a proper business system rapidly. + +The following are the printed directions referred to by Colonel Onslow: + + HEADQUARTERS, CAIRO. + _From_ A.D.M.S., Australian Force, + Headquarters, Cairo. + + _To_ O.C. Troopship---- + +1. Will you please instruct a Medical Officer to make a list in +duplicate of the surplus medical stores and Red Cross goods, including +ambulances, on the ship. He will hand one list to the representative of +Australian Intermediate Base (Captain Clayton) and retain the other. + +2. Will you please detail a Medical Officer, or if that be impossible +another Commissioned Officer, who will see that these goods are put on +the train, and travel with them to their point of destination. + +3. At the place of destination he will hand them over with an inventory +to a representative of A.D.M.S. Australian Force (Lieut.-Colonel +Barrett), from whom he will obtain a receipt. He will not, under any +circumstances, hand them over to any one else, or take any verbal +receipt. + +4. If it be impossible to send the goods by passenger train they may +proceed by goods train, in which case an N.C.O. or orderly must be +detailed to travel in the brake van; and deliver the goods to a +representative of A.D.M.S. Australian Force (Lieut.-Colonel Barrett) in +precisely the same way. + +5. You will please detail a fatigue party of sufficient strength for +unloading the goods from the transport and placing them on the train, +and in addition supply any guard that is necessary to protect them until +this work is completed. + +6. It is undesirable in any circumstances to send goods by troop train. +It is much better to send them by goods train. + +7. Will you please convey these orders in writing to the Medical Officer +or Officer concerned. If any conflicting orders be issued he can then +produce this authority. + + A.D.M.S. AUSTRALIAN FORCE. + +4. _Distribution of Goods._--The distribution of goods was effected on +requisition signed by the O.C. of the medical unit requiring them, +transport was provided by the Red Cross Society to the railway station +(usually by motor lorries) and at public expense on the railways. I soon +learnt that in Egypt in time of war there is no certainty of the +delivery of the goods to the proper quarter unless some one is sent with +them. The railway officials will frequently hand over goods to a +military officer without obtaining a receipt. Accordingly one or more +orderlies were sent with every train conveying Red Cross goods. They +handed the goods to the consignee and brought back the receipt. + +In the Australian hospitals the distribution of goods was effected by +two methods. Anything wanted from the central store could be obtained by +requisition signed by the O.C. of the hospital, and countersigned by +myself as Red Cross officer. Very large quantities of goods were thus +transferred from the central store to the quartermaster's department. +They were then issued in the ordinary way by requisition of the sisters +or medical officers, and those receiving them were not aware whether +they were receiving Red Cross goods or Ordnance goods. The system had +the merit of extreme simplicity, and was very speedy in its operation. +It certainly seemed at the time far less important that patients should +know where the goods came from than that they should obtain them +promptly. Later on the expediency of putting a Red Cross label on +everything supplied became obvious and was adopted as a policy. + +5. _Scope of Operations._--At first the operations of the Society were +confined to Egypt, but soon, in conjunction with the British Red Cross, +goods were forwarded to the Dardanelles and elsewhere. The tables show +the quantity of goods sent to transports in the Mediterranean and +transports leaving for Australia. No request was ever refused. When +dispatching goods to the Dardanelles it was considered better to act, +as far as possible, through the British Red Cross Society. + +On July 5 I wrote to General Birdwood, Commanding Officer A. and N.Z. +Army Corps, asking him whether I could establish a Red Cross store at +Anzac. He replied that it was impossible, but at his suggestion a Red +Cross store at Mudros in the island of Lemnos was organised in +conjunction with the British Red Cross Society. The Army Medical Corps +at Anzac was then advised to requisition on Mudros. The difficulties, +however, of landing goods at Mudros were very great--so great that the +British Red Cross Society was compelled to buy launches and lighters. +The Australian Red Cross Commissioners are about to supplement the +purchase. The tables show the quantity and character of the goods sent +forward in spite of many difficulties. It was often necessary to send an +orderly in the hospital ship to Mudros and Anzac to ensure delivery. + +6. _Other Activities._--The British Red Cross Australian Branch arranged +through the Y.M.C.A. for the free distribution of stationery to the +soldiers in hospitals in Egypt. With the assistance of the Y.M.C.A. and +some English ladies in Cairo a number of committees were formed to +entertain the sick and wounded in various ways. A cinema was purchased, +a small orchestra was engaged to visit the hospitals, bands of ladies +agreed to take flowers and the like to the hospitals, and everything was +done that could be done to render the tedium of convalescence less +objectionable. + +Large recreation huts were built at many of the hospitals at the expense +of the Australian Branch. + +This phase of the work should not be passed over without the most +handsome acknowledgment to the English ladies in Cairo. These +public-spirited ladies, headed by Mrs. Elgood, thoroughly organised what +I may call the lighter side of hospital work, and not only by their +personal attention, but also by their tactful skill, succeeded in making +the conditions of the sick and wounded much more comfortable. +Furthermore although we left Australia knowing that the Y.M.C.A. did +good work in camps, yet the practical experience of the Y.M.C.A. work in +Egypt has left an indelible impression on our minds. Headed by Mr. +Jessop, their secretary, there was no service in connection with the +sick and wounded which they failed to render when provided with the +proper means. We felt the utmost confidence in entrusting them with any +undertaking, provided that the position was clearly defined and provided +that they were not hampered in their activities. + +In passing it may be said that until June 15 the shortage of nurses and +medical officers was considerable. Of lay helpers there were few in +Cairo during the summer, and the principle was invariably adopted of +using all existing agencies to cover the ground, the necessary support +being given by the Red Cross Society. It was on this principle that Mrs. +Elgood acted, it was on this principle that the Y.M.C.A. acted, and it +is on this principle that all great organisations can be most +successfully conducted. If it had become necessary to create an +independent organisation to provide cinemas and bands, to disburse +stationery in Egypt and at the Dardanelles, distribute flowers, fruit, +games, etc., a very large number of soldiers would have been employed +who were much better employed otherwise. Furthermore, they would not +have done the work as well as Mrs. Elgood's staff or the Y.M.C.A. + +7. _Issue of Purchased Goods._--As the fund grew in volume it was +decided to spend some of it in the purchase of articles desired by the +men. A vote was taken at No. 1 Auxiliary Convalescent Depot (Luna Park) +to ascertain the articles the men most desired--see appendix. Boxes +containing a number of articles were issued to every patient on +admission. This has involved an expenditure rising to £500 per month. A +sample box has already been sent to Australia. In each box the following +note was placed: + +"The object of the Australian Red Cross Society is to provide comfort +and help to the wounded and sick soldiers, such as hospital clothing, +invalid comforts, tobacco, toilet necessaries, books, magazines, +newspapers, and the like, and also recreation huts for entertainment, +etc. + +"These comforts are supplied over and above the hospital necessaries +which the Commonwealth of Australia furnishes on so liberal a scale. + +"The Society hopes that your stay in the hospital will be short and +pleasant, and that your convalescence will be rapid so that you can +speedily serve your country again. The Society asks you to accept the +contents of this box as an indication of Australia's desire to help +you." + +8. _Convalescent Home at Montazah._--The Montazah palace, which was +owned by the late Khedive, was offered to Lady Graham by H.H. the Sultan +as a Convalescent Home for soldiers. The British Red Cross Society and +the Australian Branch combined and agreed to find £3,500 to equip it. +This beautiful hospital consists of a number of buildings situated on +the shore of the Mediterranean, with artificial harbours and provision +for bathing, fishing, and boating. It is now in excellent order and is +most successful. + +While I think it was right to take a share in the erection of this +convalescent home, which indeed could not have been obtained as a +military hospital, it immediately raised in mind the consideration of +the propriety of the Red Cross conducting hospitals in any +circumstances. It is of course the English practice, and the special +circumstances of Great Britain may make it necessary to erect Red Cross +hospitals. The Commonwealth of Australia has never prevented the +establishment of as many hospitals as may be considered necessary in the +field. In my judgment it is better to limit the conduct of military +hospitals and convalescent hospitals to official authority, leaving the +Red Cross to supplement the work in the way already indicated. Otherwise +the Red Cross is simply doing Governmental work. The Red Cross may do +the work very well indeed, but the advantage is not obvious. + +9. _Motor Transport._--The motor ambulances presented by the Australian +Branch have been housed in two garages, one at Heliopolis and the other +at Gezira. They were both designed by Surgeon-General Williams and +provided from Red Cross Funds. It is not too much to say that the +organisation of the motor transport assisted materially in saving the +position. For a long time, with the exception of some New Zealand +ambulances, there were no other ambulances in Egypt. At Heliopolis a +repairing plant was installed at Red Cross expense in order to reduce +the cost of repairs. + +There is no doubt that the British Red Cross Australian Branch was at +the outset of exceptional service because it possessed on the spot +stores, money, and motor transport. + +10. _Bureau of Inquiry._--The British Red Cross Society instituted a +bureau of inquiry in order to obtain supplemental information about the +sick and wounded. Inquiries on an elaborate scale are made at the office +of the Commonwealth Government, but certain supplementary and private +inquiries can be made with profit. The British Red Cross Society was +requested to undertake such inquiries and to charge Australian Red Cross +for the extra assistance necessitated. + +11. _Hospital Trains._--At an early stage steps were taken to equip +hospital trains running from Alexandria to Cairo with everything the +officers in charge required. + +Furthermore, arrangements were made at Red Cross expense to provide a +restaurant car on all trains conveying sick and wounded to Suez. For +detailed arrangements see page 166. This arrangement has proved of great +benefit. The men obtained free lime juice and water and their rations. +They could purchase in addition comforts at bed-rock prices. The +innovation may seem a small one, but it was not effected without +considerable trouble owing to shortage of rolling stock. + + +LIST OF RED CROSS GOODS ISSUED TO UNITS FROM END OF MARCH TO +SEPTEMBER 3, 1915 + + _Prepared by Staff-Sergeant Hudson_ + + Unit. Articles. Cases. Pkgs. + First Australian General Hospital 76,350 462 39 + No. 1 Auxiliary Convalescent Depot 3,377 22 + No. 2 Auxiliary Convalescent Depot 11,340 78 7 + No. 3 Auxiliary Convalescent Depot 6,393 74 13 + Infectious Diseases Hospital, Choubra 6,303 7 + Ras el Tin Convalescent Home 19,562 65 8 + Al Hayat Convalescent Home 36,050 92 2 + No. 2 Australian General Hospital, Ghezira 25,437 75 4 + Mena Australian Hospital 2,705 4 2 + Venereal Diseases Hospital, Abbassia 7,626 22 2 + Hospital ships and transports 46,350 19 + Imbros Rest Camp Hospital 650 70 + Kasr el Aini 13,372 11 + Greek Hospital, Alexandria 1,381 + Colonel Bryant, Lemnos 23,236 127 8 sacks + 4th Field Ambulance, Dardanelles 8,472 2 + 1st Stationary Hospital, Lemnos 42,333 107 12 sacks + 2nd Stationary Hospital, Lemnos 187 107 13 sacks + 7th Field Ambulance, Polygon Camp, Cairo 4 2 + 2nd Light Horse Field Ambulance, + Maadi, Cairo 6,056 2 + 2nd Light Horse, Lemnos 7,985 2 + Captain Dunlop, 18th Battalion 37 + Captain Williams, Hqrs. 2nd Austr. Division 30 + No. 4 Auxiliary Convalescent Depot 754 + Heliopolis Dairy Company for 1st A.G.H. 800 + Zeitoun Convalescent Camp 2,250 13 + 6th Light Horse 560 + Dr. Hastings 500 + No. 17 General Hospital, Alexandria 3,532 + Deaconess Hospital, Alexandria 1,733 6 + Egyptian Army Hospital, Abbassia 708 6 + 2nd Indian General Hospital 6,486 + Dr. Oulton, Tanta Hospital 3,899 + Mustapha Barracks, Alexandria 4,585 + New Zealand Mounted Rifles 736 1 + Lancashire Fusiliers 1,116 + No. 15 General Hospital, Alexandria 4,199 + Military Hospital, Cairo 244 1 + School Hospital, Port Said 700 + Red Cross Hospital, Saideh School 3,456 2 + No. 4 Base, Medical Depot, Alexandria 13,032 + Convalescent Hospital, Ismailia 1,904 + French Convalescent Hospital, Alexandria 2,294 + Ordnance Office Base, Alexandria 9,528 + European Hospital, Alexandria 740 + 4th Field Ambulance 1,250 + ------- ----- --- + Total 411,974 1,357 110 + ======= ===== === + + +LIST OF RED CROSS GOODS SUPPLIED FROM STORE APART FROM OTHER GOODS +PURCHASED AND SUPPLIED + + Aprons (surgical) 260 + Blankets 5,875 + Cholera belts 7,400 + Hot-water bottles 407 + Bandages 51 cases + " 200 + Books 87 pkgs. + Caps 2,010 + Caps (surgical) 266 + Dressing-gowns 184 + Handkerchiefs 46,298 + Housewives 776 + Cardigan jackets 3,483 + Hospital jackets 269 + Pneumonia jackets 341 + Old linen 90 cases + Mufflers 3,662 + Masks (surgical) 24 + Nightingales 495 + Overalls (surgeons') 243 + Pillows 2,945 + Pillowslips 24,501 + Pyjamas 17,300 + Pyjama trousers 881 + Pipes 1,570 + Quilts 43 + Sheets 7,240 + Draw sheets 4,032 + Shirts (flannel) 24,876 + Shirts (cotton) 9,913 + Hospital shirts 4,725 + Socks 70,725 + Bed socks 1,018 + Toilet soap 2,789 cakes + " " 4 cases + Slippers 5,878 + Towels 43,914 + Medical towels 4,183 + Undershirts (flannel) 12,333 + Underpants (flannel) 5,588 + Vaseline 284 + Face washers 37,665 + Binders 200 + Hospital bags 334 + Soldiers' kit bags 4,710 + Air cushions 17 + Tooth brushes 6,885 + Tooth paste 1,552 + Sea kit bags 717 + Hair brushes 1,047 + Hair combs 1,081 + Ointment 208 + Playing cards 723 + Pencils 176 + Safety pins 380 + Rubber sheets 6 + Mosquito nets 1,251 + Insect powder 314 pkts. + Sponges 2,756 + Tobacco 2,379 plugs + " 16 cases + Cigarettes 3,741 pkts. + " 1 case + Biscuits 64 cases + Extract of beef 45 " + Soap 1,120 bars + " 70 cases + Gooseberries 66 " + Glaxo 38 " + Milk 36 " + Beans 20 sacks + Peas 13 " + Jam 172 cases + Syrup 54 " + Tomatoes 51 cases + Milk and cocoa 5 " + " " 69 tins + Pineapples 98 cases + Apricots 49 " + Honey 8 " + Dried apples 47 " + Dried peaches 115 " + Pears 43 " + Foodstuffs 77 " + " 55 pots + Malted milk 6 cases + Chocolate and sweets 2 " + " " 634 " + Extract of malt 3 " + Rolled oats 1 case + Lactogen 7 cases + Ground sheets 22 + Cloth caps 2,984 + Games 65 + Walking-sticks 16 bundles + " 687 loose + Writing-pads 1,206 + Envelopes 28,470 pkts. + Lemons 15 cases + Glass towels 325 + Sun glasses 108 + Hot-water bottle covers 260 + Dusters 773 + Mattresses 9 + Swabs 7 cases + " 500 + Candles 1 case + Cane chairs 70 + Toilet paper 45 cases + Puddings 1 case + Preserved fruit 47 cases + Linen coats 388 + Cushions 115 + " 3 cases + Fly whisks 725 + " 2 cases + Knives 30 + Spoons 95 + Wine 8 cases + Deck chairs and camp stools 340 + Bales of clothing 25 + Brassards 200 + Shaving-brushes 1,801 + Skin coats 10 + Cotton thread 50 reels + Toilet paper 100 + Nail brushes 24 + Jug covers 100 + Mittens 673 + + +GOODS SENT TO LEMNOS + + Articles. Cases. Sack. + 1st Stationary Hospital, Lemnos 42,333 107 12 + 2nd " " " 187 107 13 + Imbros Rest Camp 650 70 + Col. Bryant, for Distribution, Dardanelles 23,236 127 8 + 2nd Light Horse, Lemnos 7,985 2 + + +AGREEMENT MADE FOR PROVISION OF REFRESHMENTS TO SOLDIERS ON INVALID +TRAINS + +1. The Restaurant Car can be placed on the train and the cost of same, +£7 10s., guaranteed by Lieut. Colonel Barrett. + +2. Meals will be provided for Commissioned Officers, P.T. 20 lunch or +dinner, P.T. 5 afternoon tea, at stated times. + +3. Meals and afternoon tea will be provided for N.C.O.s in the +Restaurant Car at half price. + +4. Sandwiches, P.T. 1, and non-alcoholic drinks (soda water, lemonade, +etc.), P.T. 1, will be served in the cars by the attendants of the +Restaurant Car to soldiers who desire to purchase them. + +5. In addition, water will be provided in each carriage for the use of +soldiers in fantasses, and lime juice will be supplied, two bottles in +each carriage, free. + +Notice to this effect will be posted in every carriage on the troop +train. + + _July 1, 1915._ + +[Illustration: HELIOPOLIS SIDING: ARRIVAL OF WOUNDED. +_To face page 166_]] + +12. _Soldiers' Clubs._--Reference has been made in the chapter on +Venereal Diseases to the damage done to Australian troops in Egypt by +venereal disease. Reference has also been made to the establishment of +soldiers' clubs and recreation huts in various places to provide a +counter-attraction to those entertainments furnished by the prostitute +and her degraded male attendants. After the various repressive steps +already referred to had been taken, an earnest attempt was made to +organise this constructive work. The valuable assistance of Mr. Jessop +and the Y.M.C.A. was again invited. The Y.M.C.A. proposed to build in +Alexandria on the sea front a large building to be used as a central +soldiers' club, and to be available for convalescents and the healthy. +The Y.M.C.A. had only £250 available and required £1,000. The British +Red Cross Society was appealed to and hesitated. A cable was dispatched +to London, and an expenditure of £250 authorised. Surgeon-General +Williams, after consultation with His Excellency Sir Henry MacMahon, the +G.O.C.-in-Chief, Sir John Maxwell, and the D.M.S. Egypt, General Ford, +decided to make a grant of £500 in addition for the purpose. The club +was opened on September 12, and from its opening was a pronounced +success. The soldier on leave, tramping about the streets of Alexandria, +gets leg-weary and falls an easy victim to the wiles of the various +agents abroad. He now can visit his own club, where the entry is free to +all men in uniform. He there receives war telegrams, stationery, cheap +and excellent meals, and enjoys various forms of entertainment. He meets +his friends, and can spend the time under the most pleasant conditions. +The building already requires extension, as the pressure on the +accommodation is so great. Similar action was taken in Cairo, where +after many unsuccessful attempts the Rink Theatre in the beautiful +Esbekieh gardens was obtained, owing to the sympathetic help given by +His Excellency Sir Henry MacMahon and other authorities. This open-air +theatre is a little over an acre in extent, and is a valuable property. +It had been leased to a restaurant keeper in the vicinity. Arrangements +were made for the supply of light refreshments at bed-rock prices in the +theatre, and other meals at low prices at the restaurant which is about +fifty yards away. In addition a soldiers' club, managed by ladies, is +equidistant, and at this comfortable resort refreshments are supplied in +quiet rooms at low rates. Naturally the club has become a resort for all +the soldiers in Cairo. Major Harvey, Commissioner of Police, has cleared +the surrounding gardens of undesirable characters. The club was placed +under the management of a joint committee of which Her Excellency Lady +MacMahon is Patroness, and Lady Maxwell is President. The executive +committee consists of three members of the Y.M.C.A., and the expenses of +managing the club were provided by the British Red Cross Society, +Australian Branch, for the first three months. It was soon found that in +order to make the club successful the athletic element must be +developed, and splendid programmes were arranged--boxing, fencing, +skating contests, and the like. The club provides writing-paper, games, +war telegrams, Australian and other newspapers, shower baths, and other +conveniences. As many as 1,500 soldiers are present on some of these +occasions, and the club is visited by officers who periodically drop in +amongst the men. Altogether the success has exceeded even the sanguine +expectations of those who founded it. + +The British Red Cross Society, Australian Branch, was most fortunate in +securing such a site, as any one acquainted with the conditions of Cairo +is fully aware. + +[Illustration: MATRONS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL. +_To face page 169_]] + +The exact extent to which these clubs have contributed to the limitation +of venereal disease cannot be accurately measured, but there is no doubt +whatever in the minds of any one acquainted with the facts respecting +their salutary and healthy influence. Under the new constitution of the +Australian Red Cross money cannot be devoted to their maintenance, +because it is not being used exclusively for the sick and wounded. Such +is the ruling, although many convalescents use the clubs. It is +regrettable that such a rigid ruling should have been established. It is +absurd to permit men to become infected and then to assist them by doles +of chocolate and tobacco, and yet to refuse to provide the necessary +funds which assist so materially in preventing infection. + +13. _Nurses' Rest Homes._--The nurses in the hospitals had done +excellent work under trying conditions, and it became obvious that many +of them would break down unless holidays and rest were provided. + +The British and Australian Red Cross Branches combined under the +Presidency of Her Excellency Lady MacMahon, and opened two rest +homes--one in Ramleh near the beach, and the other at Aboukir Bay, the +site of Nelson's victory. + +They were furnished by the Red Cross Societies and have been maintained +by the Commonwealth Government so far as the Australian nurses are +concerned. They have met a great want and have proved a boon and a +blessing. + +_Conclusion._--The work has been very heavy and the circumstances far +from easy. Taking everything into consideration and realising the +pressure at both ends, the result can only be regarded as more than +satisfactory. The policy of the Red Cross Society requires, however, +some consideration. + +The policy adopted until lately was that reasonable intimation should be +given to the Red Cross Society of the requirements of those who want +help. Under public pressure another policy may make its +appearance--that of compelling the Red Cross Society to find out what +people want. A word of caution is necessary. This policy will almost +certainly result in the creation of an extensive business organisation +and in the Red Cross undertaking much work which the Government should +do. In my opinion the Red Cross Society is entirely ancillary, its +functions being to provide comforts and other things which the +Government cannot supply, and to act decisively at critical moments. It +should, however, refrain from embarking on great national undertakings. + +Every one will endeavour to help the Commissioners in their extensive +and difficult task, and will look forward to the Australian Red Cross +maintaining the high reputation which it has already gained amongst +responsible officers in Egypt. + +In conclusion it should be pointed out that during the whole period +under review all necessary services were provided by the military +authorities and the Red Cross was administered on military principles. +Consequently there were no large expenses, no one received any money in +payment for services, and the storage of goods was free. + +If the Red Cross is to be administered on non-military lines many +charges must be properly made and met, but the efficiency of the system +instituted and now set aside must be judged largely from the standpoint +of economic administration. + + JAMES W. BARRETT, + _Lieut.-Colonel_. + +(In this volume the original report forwarded to Melbourne has been +expanded and amplified.) + + +APPENDIXES + + 1. _Directions for the Conduct of the Red Cross Depot_ + + Depot--conduct of. 1. The Depot is placed under + the charge of a Medical + Officer who will have at + his disposal nurses and + orderlies in such numbers + as the work from time to + time may necessitate. + + Storage of goods. 2. All goods consigned to the + Red Cross Depot shall be + placed in store at once + and rendered secure under + lock and key at other + than business hours. + + Receipt Book. 3. All goods received will be + entered in the Goods Receipt + Book. + + Requisitions--how 4. On receipt of requisitions + dealt with. signed by the Officer Commanding + any unit, and + countersigned by the + Officer Commanding + First Australian General + Hospital, goods will be + issued, and if necessary + transport provided. Two + clear lists shall be prepared + on forms provided + for the purpose, one to be + receipted and returned to + Red Cross Depot by the + consignee and duplicate + to be filed in Office. + + Stock-taking. 5. A Stock Book is to be kept + showing the nature and + quantity of material received, + and the quantity + distributed, so that at + any time the stock remaining + can be ascertained. + This book to be + checked once a month by + stock-taking of the contents + of the store and + certified to by the M.O. + in charge. + + +2. _Result of Vote at No. 1 Auxiliary Convalescent Depot_ + +The following items represent the wishes of 840 patients at Luna Park on +July 29, 1915, ascertained by the O.C., Major Brown. + +Four hundred and forty papers were received, a great number of patients +failing to vote. + +The patients were asked to make a list of twenty to thirty articles that +would add to their comfort during their stay in hospital, and which +could be supplied by a small fund at his disposal. + +The average items on collected lists were 8. + + Razors 249 + Shaving-sticks 244 + Razor strops 241 + Toothpaste 221 + Cigarette 194 + Toilet soap 188 + Matches 170 + Mirrors 177 + Shaving-brushes 163 + Tooth-brushes 148 + Handkerchiefs 131 + Tobacco 121 + Pipes 106 + Hairbrushes 99 + Writing material 98 + Haircombs 96 + Fruit 63 + Chocolate 54 + Socks 37 + Sweets 32 + Pocket knives 30 + Playing cards 21 + Lead pencils 19 + Housewives 14 + Cigars 11 + Biscuits 10 + Walking-sticks 8 + Shirts 8 + Singlets 7 + Belts 6 + Tobacco pouches 4 + Fountain pens 3 + Bottles of ink 3 + Nail brushes 3 + Boot laces 3 + Post cards 3 + Mouth organs 3 + Cigarette holder 1 + Cigarette lighter 1 + " papers 1 + Sponge 1 + Pair scissors 1 + Soap box 1 + Nuts 1 + Dark eye-glasses 1 pair + Blades for safety razors 1 set + Notebook 1 + + +3. _Fence or Ambulance?_ + +Some critics have objected to the Red Cross assisting Soldiers' Clubs. +The following lines are commended to their notice. But for the +Australian Branch British Red Cross there would have been no such +Soldiers' Clubs as those provided at Esbekieh and Alexandria. + +[Illustration: SOLDIERS' CLUB, ESBEKIEH, CAIRO. +_To face page 174_]] + + + 'Twas a dangerous cliff, as they freely confessed, + Though to walk near its crest was so pleasant; + But over its terrible edge there had slipped + A duke, and full many a peasant. + So the people said something would have to be done, + But their projects did not at all tally: + Some said, "Put a fence round the edge of the cliff"; + Some, "an ambulance down in the valley." + + But the cry for the ambulance carried the day, + For it spread through the neighbouring city, + A fence may be useful or not, it is true, + But each heart became brimful of pity + For those who had slipped over that dangerous cliff; + And the dwellers in highway and alley + Gave pounds or gave pence, not to put up a fence, + But an ambulance down in the valley. + + "For the cliff is all right if you're careful," they said, + "And if folks even slip and are dropping, + It isn't the slipping that hurts them so much + As the shock down below when they're stopping." + So day after day, as those mishaps occurred, + Quick forth would these rescuers sally + To pick up the victims who fell off the cliff, + With the ambulance down in the valley. + + Then an old sage remarked, "It's a marvel to me + That people give far more attention + To repairing results than to stopping the cause + When they'd much better aim at prevention. + Let us stop at its source all this mischief," cried he, + "Come, neighbours and friends, let us rally! + If the cliff we will fence we might almost dispense + With the ambulance down in the valley." + + "Oh, he's a fanatic," the others rejoined. + "Dispense with the ambulance? Never! + He'd dispense with all charities, too, if he could! + No, no! We'll support them for ever! + Aren't we picking folks up just as fast as they fall? + And shall this man dictate to us? Shall he? + Why should people of sense stop to put up a fence + While their ambulance works in the valley?" + + But a sensible few, who are practical too, + Will not bear with such nonsense much longer; + They believe that prevention is better than cure, + And their party will soon be the stronger. + Encourage them, then, with your purse, voice, and pen, + And (while other philanthropists dally) + They will scorn all pretence, and put a stout fence + On the cliff that hangs over the valley. + + Better guide well the young than reclaim them when old, + For the voice of true wisdom is calling: + "To rescue the fallen is good, but 'tis best + To prevent other people from falling. + Better close up the course of temptation and crime + Than deliver from dungeon or galley; + Better put a strong fence round the top of the cliff, + Than an ambulance down in the valley." + + JOSEPH MALINES. + + +THE RED CROSS POLICY: WANTED, A DEFINITION + +Before leaving consideration of the details of the Red Cross question, +attention should be directed to the numerous changes in the policy +adopted by the British Red Cross Society, Australian Branch. No less +than three different types of administration were rapidly adopted. It +was first placed in the hands of Surgeon-General Williams and the High +Commissioner for Australia, in London; then it was placed under a +committee in Egypt formed by the High Commissioner for Egypt, Sir Henry +MacMahon, and six weeks later two Commissioners were appointed to take +the work over. Nothing more clearly illustrates the state of mental +instability in which a first experience of war had thrown the population +of Australia. The policy which was adopted by Surgeon-General Williams +in connection with the Red Cross administration is that which we believe +to be sound. + +When acting as A.D.M.S. to the Australian Force in Egypt it became my +duty (Lieut.-Col. Barrett) to sanction or modify the requisitions of +medical stores for the various hospitals and units, and the instructions +conveyed to me were that I could sanction any requisition provided that +it was reasonable. If, however, it represented a new departure it must +be authorised by the D.M.S. Egypt. This meant practically that +everything could be obtained from Ordnance, and many of the Red Cross +supplies became superfluous. That is to say, any necessary goods in the +Red Cross store were utilised, but if they had not been there the +Government would have purchased them. In fact, it reduced the field in +which the Red Cross could operate to comparatively small proportions. +There is no doubt that, had it become necessary, I should have +authorised the erection of shelter sheds and recreation huts in the +various hospitals as a medical necessity. There was one advantage, and +one advantage alone, in effecting these changes with the aid of the Red +Cross. The action if sanctioned by superior officers could not be +challenged by any one else at the time, and could be effected with +extraordinary speed. + +I took the view that it was the business of the Officer Commanding the +hospital, with the aid of the matron, sisters, and medical officers, to +let me know what was thought necessary, and unless the requirement was +outrageous it was immediately supplied. As a matter of fact no single +request for money or goods was ever refused or seriously modified. Owing +to pressure of public criticism another policy began to make its +appearance. It was asserted that it was the duty of the Red Cross +officer to visit the various hospitals to find out what the patients +ought to receive. It will be seen that such a policy removed from the +O.C.s of the hospitals, or any one to whom they may have delegated their +powers, the responsibility for determining what patients should receive. +Such a policy sooner or later must result in the creation of an army of +people who are worrying to find out what they can do instead of being +properly instructed by those responsible for the welfare of the +patients. + +It further tended to place in the hands of irresponsible people some +control over the medical management of hospital cases. If lay visitors +can enter a hospital and provide food for patients, they may next wish +to provide drugs, etc. It seemed that the policy laid down in the first +instance was sound, useful, and healthy. + +When the Commissioners took office they made a number of changes in +detail. They shifted the position of the store; they printed different +forms of requisition, and they took the goods out of the quartermaster's +store and placed them in a store in the hospital, presided over by a +volunteer. The goods were then obtained by requisition from the sisters +and the matron. But as the President of the Red Cross Inquiry Court +pointed out, with one trifling exception the method was not really +altered. The control had simply ceased to be military, and had become +civil. Consequently a large staff of capable people were withdrawn from +their ordinary occupations in Australia, and devoted themselves to an +administration which had been hitherto effected entirely by the +soldiers. We do not think that the change was right or desirable. It +resulted in the creation of another body, not responsible directly to +the military authorities, to do what is after all subsidiary work. The +inevitable tendency will be for the Red Cross to take on function after +function which should be undertaken by military authorities. The Red +Cross is already supplying many articles which should be, and can be, +supplied by Ordnance. For there is nothing that the Red Cross can supply +that Ordnance cannot still more easily supply. It is quite true that the +British Red Cross is managed on civil lines, and the British Red Cross +supplies goods and does not supply money. But with a full knowledge of +both systems we are strongly of opinion that the military method of +management is in every respect preferable. + +During the Red Cross Inquiry recently finished, to which allusion will +be made elsewhere, day after day was necessarily spent by the Court in +endeavouring to decide what Red Cross should supply and what Ordnance +should supply. What does it matter so long as the patient receives the +articles? It does not concern him where they come from, and if the whole +is under military control there is no need for this sharp and artificial +line of demarcation. We are of opinion that in general the functions of +the Red Cross should be to supply those additional comforts and +accessories which make sick life more tolerable, to supply any goods +which may be donated, and to make helpful donations of money in the way +already indicated. + +The presence in the store at Heliopolis of large quantities of +goods--sheets, blankets, pillows, and the like--which could have been +supplied by Ordnance, enabled us to rapidly tide over a great emergency. +There is no doubt that the possession of money and goods by the Red +Cross will prove of vast service in every campaign by reason of its +emergency value. In fact the rapid expansion of No. 1 General Hospital +during the crisis of May and June would not have proceeded with such +smooth expedition had it not been for the large quantities of Red Cross +stores which lay to hand and were instantly passed into the +Quartermaster's department. If, however, the supply had been under lay +control, we can quite imagine circumstances in which argument, +requisitions, forms, etc., might have seriously delayed operations. + +Whilst on this subject reference must be made to the help afforded to +the hospitals by Red Cross workers. Two schools of thought existed. Some +Commanding Officers preferred to have no helpers, because of the trouble +some of them gave. Others passed to the other extreme. Our own +experience was that the workers organised by Mrs. Elgood were most +helpful for the functions they undertook, with one or two exceptions, +but those exceptional people gave a certain amount of trouble. They came +not to help, but to criticise, and they carried their criticisms not to +the Commanding Officer, but to the Australian public, and so caused +trouble. + +We are convinced that the Japanese method of organising the Red Cross is +sound. It is organised and disciplined in time of peace, and when war is +declared it becomes part of the army medical reserve and is mobilised +for service. Every one is under military control, and consequently +these crudities are avoided. If we were to repeat our experience we +should have welcomed the visitors, but insisted that they should be +under some measure of discipline, and that a serious breach of +regulations should be followed by their withdrawal. In some instances +visitors wrote to the Commander-in-Chief, and complained of the food the +patients were getting. The Commander-in-Chief sent the letters on to us, +and we then brought the visitor in contact with the Commanding Officer +of the hospital, and the complaint was investigated. How much more +direct and simple it would have been if the visitor who saw something he +believed to be wrong had immediately asked for the Officer Commanding! +But the "secret and confidential" candid friend is apt to become +somewhat of a pest. + +There is another and more serious aspect of the matter. The medical +officer is alone competent to judge what food should be issued to +patients. Visitors who criticise the diet of the patient are assuming a +function which they are obviously unable to discharge. Diet sheets are +provided for each ward, and on these is entered the number of different +diets prescribed by the medical officer. These diet sheets should be the +only and the final authority of what should be issued to the patient in +the way of eatables. As it happened, ladies sometimes brought into the +different wards of the hospital foods which constituted an added danger +to the patient. On one occasion green melons were issued to a large +number of sick men by kind-hearted visitors. The men became so ill that +the medical officer confiscated the melons, made inquiries, and only +then ascertained the source of supply. A strong-looking soldier on a +milk diet might evoke the sympathies of a lady visitor, who lodged a +complaint regarding the supply of food, but the nature of his disease +and the method of treatment adopted by his medical officer are surely +the principal consideration. As everything conceivable in the nature of +food and drink can be supplied through these diet sheets, the obvious +course is to pass all Red Cross foodstuffs directly into the +Quartermaster's department to be distributed in the ordinary, and the +only safe, channel. This was the practice followed at Heliopolis. + +The following articles were supplied in this way at the time of +expansion, and show what assistance a properly controlled Red Cross +system can render. + + +QUARTERMASTER'S REPORT BY LIEUTENANT P. E. DEANE + + ASSISTANCE RENDERED THE FIRST AUSTRALIAN + GENERAL HOSPITAL BY RED CROSS IN HOSPITAL + EXPANSION + + _April_ + + Skating Rink opened. + Abbassia Venereal Diseases Hospital opened. + Casino Infectious " " " + + The following were obtained immediately on requisition on Red Cross: + + Sheets 1,684 + Pillowslips 2,300 + Face washers 1,600 + Towels 2,622 + Handkerchiefs 1,000 + Blankets 61 + Pyjamas 489 + Cotton shirts 701 + Underpants 400 + Socks 600 + Flannel shirts 400 + Slippers 67 + Draw sheets 500 + Pillows 69 + Quilts 12 + Old linen cases 2 + + + _May_ + + Great rush of patients--Luna Park expanded, Palace Hotel expanded. + + Patients admitted in four days from + April 29 to May 2 1,543 + Patients admitted during May 2,650 + + RED CROSS SUPPLIES + + Sheets 1,381 + Blankets 1,038 + Towels 4,394 + Pyjamas 1,176 + Shirts 238 + Handkerchiefs 500 + Face washers 1,000 + + + _June_ + + Rush of wounded continues. Atelier occupied, Sporting Club commenced. + + Patients admitted during June 2,862 + + RED CROSS SUPPLIES + + Pyjamas 790 + Face washers 1,000 + Sheets 900 + Towels 1,500 + Sponges 1,500 + Handkerchiefs 1,500 + Cotton shirts 950 + Socks 1,000 + Slippers 500 + Pillowslips 1,000 + + Special hospital organised hurriedly by the department on June 17. + Ras el Tin Convalescent Home, Alexandria. + + RED CROSS SUPPLIES + + Socks 1,000 + Shirts 1,500 + Pyjamas 750 + Sheets 750 + Blankets 750 + Pillowslips 750 + Face washers 1,500 + + _July_ + + Wounded still pour in. Sporting Club increased by addition of + tennis court wards, Atelier and Luna Park accommodation + increased. + + Patients admitted in July 2,194 + + RED CROSS SUPPLIES + + Sheets 2,000 + Slippers 1,000 + Pillowslips 3,400 + Blankets 1,900 + Shirts 2,000 + Handkerchiefs 2,000 + Towels 3,000 + Socks 3,400 + Face washers 3,000 + + + _August_ + + Choubra Infectious Hospital hurriedly established and equipped + by the department; 400-bed tent hospital added to Sporting Club. + + RED CROSS SUPPLIES + + Blankets 2,000 + Cotton sheets 1,800 + Towels 1,700 + Handkerchiefs 2,400 + Face washers 2,300 + Socks 2,800 + Pillowslips 214 + + + + + CHAPTER X + + SUGGESTED REFORMS--DEFECTS WHICH BECAME OBVIOUS IN + WAR-TIME--RECOMMENDATIONS TO PROMOTE EFFICIENCY--DANGERS TO BE + AVOIDED--CONCLUSION. + + + + + CHAPTER X + + +The experience gained in connection with the establishment and extension +of the First Australian General Hospital suggests modifications which +should immensely increase efficiency. A base hospital modelled on the +R.A.M.C. pattern may work exceedingly well in times of peace, or when +staffed by R.A.M.C. or I.M.S. officers who have devoted their whole +lives to the work. But base hospitals constructed during a great war, +and staffed almost entirely with civilian elements the majority of whom +are untrained in administration of any kind, do not work in all cases +with the necessary degree of smoothness. It certainly does appear that +changes in the base hospital establishment might be introduced with +advantage. + +In the first place there arises the question whether it is necessary for +the Commanding Officer to be a medical practitioner, or whether, as in +the case of the convalescent hospitals, he might be a combatant officer, +or at all events a non-medical officer. The general consensus of opinion +is that he should be a medical officer, though there is a great deal to +be said on the other side. Almost the whole of his work is +administrative, though he necessarily must have a good knowledge of +clinical methods. But unless such an officer be selected not simply with +regard to seniority, but with regard to experience in administrative +methods, and unless he be tactful and watchful, troubles are very likely +to ensue. His task is beset with difficulties if he possesses character +and insists on efficiency. Whatever doubt there may be, however, about +the Commanding Officer, there need be none about many of the other +positions. A noteworthy feature of the First Australian General Hospital +was the continual complaint from the medical officers that they had not +come away to do administrative work. This distaste for administrative +work was a constant source of trouble. + +The Registrar, as the principal executive officer of the hospital, whose +business it is to carry out the decisions of the Commanding Officer, is +at present invariably a medical officer. The greater part of his work +does not need medical knowledge, and the difficulty might be obviated by +the adoption of one of two methods. Either the Registrar might be an +educated business man or he might have such a one as his immediate +understudy. In the latter event a very small portion of his day would be +taken up with the duties of the Registrar's office. + +Similarly the orderly officer, whose business it is to deal with details +concerning the rank and file, is usually a medical officer, and in some +hospitals it is the practice to change this officer from day to day. At +No. 1 General Hospital, however, his functions were so important that +one medical officer was permanently told off to do this work. There is +no doubt that the orderly officer need not be a medical officer, and +might well be an invalided combatant officer, transferred to the army +medical service. + +Owing to modern developments another officer has made his appearance +who is not provided for in any establishment--that is, the transport +officer. Motor transport has become so large a portion of the work of +the base hospital that a special officer is requisite for the purpose. +There is no reason whatever why such an officer should be a medical man. + +If these changes were made it would result in releasing at least three +officers for clinical purposes. + +The amount of clerical work that was necessitated by the returns +furnished to the War Office, the Australian Government, Headquarters +Egypt, and other departments was so great that a large staff of very +competent clerks was required. The future establishment should certainly +include not only a number of trained stenographers, but some one versed +in statistical work. The lessons to be learned are so numerous and so +important that something of the kind should be done. Furthermore, in the +Quartermaster's department there was a demand not only for +stenographers, but for men who had been accustomed to the methodical +ways of a large warehouse. + +Were all these changes made there is no doubt that the efficiency of the +administration would be increased and the burden of the work lightened. + +As regards clinical work other desirable changes might be made. Senior +men who have been in full practice, and who come to a base hospital as +physicians or surgeons with the rank of lieutenant-colonel, are apt to +be entrusted with the detailed administration of medical or surgical +wards. They are often unfitted by training for such administration and +are frequently disinclined to undertake the work. It would be far +better to leave the actual detailed administration of the wards in the +hands of a comparatively junior man with the rank of major, and to +retain these senior officers as consultants only. Consultants of course +possess great powers, since their authority as regards the clinical work +itself is absolute. They can do as much or as little as they like, but +they are in complete control and are absolutely responsible for the +treatment of the cases. Our own feeling is that in such a position they +would be far more comfortable and would be more efficient. + +On the subject of specialists there is much to be said. It is almost +incredible that a base hospital should have been formed without being +provided with an ophthalmic and aural specialist. The change has been +made since war began, but it seems inconceivable that any one should +have contemplated the efficient handling of wounds and diseases without +such aid. At the First General Hospital the ophthalmic and aural +department was the largest and most heavily worked department in the +hospital, partly owing to the fact that one of us had been appointed +Consulting Oculist to the Forces in Egypt, and that much of the work +consequently centred at Heliopolis. + +Similarly the failure of the Australian Government to provide dentists +in the first instance is difficult to understand. The day has gone by +when it is possible to exclude from the force a man who possesses +dentures or defective teeth, and it is practically impossible to +complete the work for the recruits before they leave. So it became +necessary at No. 1 General Hospital to borrow two dentists from the New +Zealand Government, to fit them out with Red Cross money and goods, and +in this way to meet informally the difficulty. Subsequently the +Australian Government appointed a corps of dentists, and the problem was +to some extent solved, though even now the demand far exceeds the +supply. There is no doubt that dentists are wanted not only at the base +hospitals, but also near the firing line, as the dispatch of a man from +the firing line to the base hospital to obtain dental treatment +represents a waste of time and money. + +It is further desirable to attach one or more anæsthetists to every +hospital. + +It must, however, be said that the constant changes of staff which took +place at No. 1 Hospital owing to the various exigencies of the military +situation rendered it extremely difficult to keep a physician or surgeon +in any fixed position for any length of time. Consequently a certain +amount of pliability and adaptability was absolutely necessary. At the +same time, if the organisation were sketched in the manner indicated, +the problem would have been more simple, and good results easier to +obtain. + +There is no doubt that one medical officer (who could be attached to the +Pathological Laboratory in addition to the Clinical Pathologist) should +devote himself entirely to sanitary work. This duty is not taken too +seriously, and should be emphasised. It would really be better to rename +this officer the "Prophylactic Officer," unless a better term can be +found, and it should be his aim and duty, not simply to enforce +cleanliness, but to actively exert himself to ward off disease. + +Stress may be laid on the usefulness of a sensible chaplain, whose +value depends on his own interpretation of his duties. The chaplain +(Colonel Kendrew) at No. 1 General Hospital not only attended to the +religious needs of men, but earned their affection and respect by +managing the extensive post office and library, the canteen, and by +helping with Red Cross work. It is just these badly defined functions in +a base hospital which a chaplain can discharge so well. + +We think also that women might be used in base hospitals as +stenographers, ward maids, telephone operators, and the like. Base +hospitals in the future are not likely to be housed in tents, and under +rough conditions. At present, trained nurses are sent to the Stationary +Hospitals. It seems a pity to waste fine young men, who could be +combatants, as orderlies in a base hospital. + +Masseurs are certainly badly wanted in a base hospital, and it is +difficult to understand the objection to their incorporation. The +difficulty was removed in Egypt by employing Egyptians. + +Electricians, _i.e._ orderlies who in civil life are electricians, are +required in every base hospital, and at Heliopolis they were invaluable +for general purposes, and as aids to the radiographer. They should, +however, form part of the establishment, and should number two or three. + +Is it not clear that chefs, laundrymen, skilled carpenters, and other +tradesmen are also required? + +The table which follows represents the establishment of the ordinary +520-bed hospital, R.A.M.C. It has been adopted by Australia, but the +Australian establishment allows for 93 nurses instead of 43. If the +foregoing suggestions are adopted, as we think they should be, this +table would require material alteration. + + + A GENERAL HOSPITAL (520 BEDS) + WAR ESTABLISHMENTS + + ----------------------+--------------------------------------------------- + ¦ PERSONNEL. + DETAIL. +---------+----+-----------+--------+--------+------ + ¦Officers.¦W.O.¦St. Sergts.¦Buglers.¦Rank and¦Total. + ¦ ¦ ¦and Sergts.¦ ¦ File. ¦ + ----------------------+---------+----+-----------+--------+--------+------ + Lieut.-Col. in charge ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 + Lieut.-Cols. ¦ 2 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 + Majors-- ¦ ¦ ¦ ¦ ¦ ¦ + Sec. and Registrar ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 + General Duties ¦ 4 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 4 + Captains or Subs. ¦ 12 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 12 + Quartermaster ¦ 1 ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 + Warrant Officers ¦ -- ¦ 2 ¦ -- ¦ -- ¦ -- ¦ 2 + Sergeants-- ¦ ¦ ¦ ¦ ¦ ¦ + Nursing Duties ¦ -- ¦ -- ¦ 4 ¦ -- ¦ -- ¦ 4 + Steward ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1 + Dispenser ¦ -- ¦ -- ¦ 2 ¦ -- ¦ -- ¦ 2 + Cook ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1 + Pack Storekeeper ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1 + Linen " ¦ -- ¦ -- ¦ 1 ¦ -- ¦ -- ¦ 1 + Clerks ¦ -- ¦ -- ¦ 3 ¦ -- ¦ -- ¦ 3 + Buglers ¦ -- ¦ -- ¦ -- ¦ 2 ¦ -- ¦ 2 + Corporals-- ¦ ¦ ¦ ¦ ¦ ¦ + Steward ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + Cook ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + Clothing Storekeeper¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + General Duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + Supernumeraries ¦ -- ¦ -- ¦ -- ¦ -- ¦ 3 ¦ 3 + Privates-- ¦ ¦ ¦ ¦ ¦ ¦ + Steward's Stores ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 ¦ 2 + Cooks ¦ -- ¦ -- ¦ -- ¦ -- ¦ 3 ¦ 3 + Pack Stores ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + Linen " ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + Clothing " ¦ -- ¦ -- ¦ -- ¦ -- ¦ 1 ¦ 1 + Clerks ¦ -- ¦ -- ¦ -- ¦ -- ¦ 2 ¦ 2 + Ward duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 66 ¦ 66 + Batman ¦ -- ¦ -- ¦ -- ¦ -- ¦ 25 ¦ 25 + General Duties ¦ -- ¦ -- ¦ -- ¦ -- ¦ 11 ¦ 11 + Supernumeraries ¦ -- ¦ -- ¦ -- ¦ -- ¦ 6 ¦ 6 + ----------------------+---------+----+-----------+--------+--------+------ + TOTAL ¦ 21 ¦ 2 ¦ 13 ¦ 2 ¦ 126 ¦ 164 + ----------------------+---------+----+-----------+--------+--------+------ + +With reference to the duties of N.C.O.s and men, nothing gave more +trouble than the fact that men recruited in Australia were made N.C.O.s +before their special qualifications were known. There is no officer in +the Army whose position is so thoroughly safeguarded as the N.C.O., and +nothing but the adverse decision of a court martial can effect his +removal. Yet an unsuitable and even dangerous man, from the point of +view of the sick, may do nothing to warrant a court martial (which no +one enjoys). These appointments should be made therefore with great +care. Such considerations, of course, lead to but one conclusion, viz. +the necessity for sketching out these hospitals in time of peace. +Scratch enlistments are too dangerous. + +The "grouser" is always with us, and sometimes gives trouble. The +particular Australian "grouse" was that the Australian hospitals should +have been nearer the front than Cairo, and at last No. 3 Australian +General Hospital was placed at Mudros. + +Now we have always understood that a large base hospital cannot be +placed far from a great city. A city grows in a particular place for +natural reasons--water supply, lighting, transit, etc. The hospital gets +the benefit of all these agencies, whereas it was necessary at Lemnos to +create them. The result was somewhat disastrous as regards supplies, and +might have been foreseen. + +"Grousers" should stay at home, and exercise their privileges there. + +The difficulties of obtaining supplies by requisition were easily +surmounted at Heliopolis because of the broad policy adopted by the +Officer Commanding the Australian Intermediate Base, Colonel Sellheim, +C.B. + +[Illustration: N.C.O.S AND MEN, NO. 1 AUSTRALIAN GENERAL HOSPITAL. +_To face page 197_]] + +Ordnance cannot supply the varied requirements of a group of expert +medical officers during a great war, and delays cause untold annoyance +to active men. On the other hand, it would never do to give the staff a +free hand to purchase when and how it pleased. + +The institution of "local purchase orders" met the difficulty. The O.C. +of the hospital sent in a requisition for something which could not be +obtained from Ordnance, marking it "urgently required." The A.D.M.S. +endorsed it, or, if it were an entirely new line, asked the D.M.S. to +endorse it. The Ordnance officer then issued a local purchase order to +the medical officer, who made the purchase. The method combined a +measure of control with reasonable speed in execution. + +We have no sympathy with the usual references to military red-tape. If +the administration is competent, the military system is thoroughly sound +from the business point of view, and from the standpoint of record +difficult to improve on. It may be at times a little cumbersome, but it +is much easier to fall in with it than to attempt to effect alteration +during war. We never had any real difficulty with requisitions, although +supplies were sometimes withheld from us on grounds of policy not +disclosed at the moment. + +There is no doubt that the erratic changes of staff were injurious. Some +medical officers preferred the front, others the base, and an attempt +was made to effect an orderly system of periodical exchange. Orders, +however, were continually arriving to send so many medical officers, so +many nurses, and so many orderlies, here and there, with the result that +at the end of ten months the original medical staff had disappeared, +many of the nurses were new, and so were most of the orderlies. +Whenever there was a shortage of staff near the front, the base +hospitals were depleted. These changes were inevitable in the +circumstances, but they emphasised the value of the advice given by +Colonel Manifold, that there cannot be too many unattached junior +medical officers in a campaign. + +The following report from Major Brown, Officer Commanding Luna Park No. +1 Auxiliary Hospital, shows what he experienced owing to these +oscillations: + + +FIRST AUSTRALIAN GENERAL HOSPITAL, LUNA PARK + + April 30 Opened with 296 + patients + May 2 790 patients Staff: 4 sisters, 4 orderlies, + and myself. With + Captains Bentley, McDonald, + and White + from Light Horse + Regiments. + May 6 Sisters increased to 13. + May 14 1,171 patients 13 sisters, 4 medicos, and + 40 orderlies (mostly + untrained). + May 18 1,244 patients + June 7 1,099 patients 41 sisters (new). + (also 65 Casino) + June 9 1,370 patients " " " + (also 65 Casino) + June 11 1,620 patients + (also 65 Casino) " " " + June 16 1,520 patients Still 4 medical officers, + Capt. Brown, Capt. + Single, Capt. Lovegrove, + and Capt. Craig. + June 17 Medical officers now increased; + sisters also + increased. + + +[Illustration: PALACE OF PRINCE IBRAHIM KHALIM (NURSES' HOME). +_To face page 198_]] + +With reference to orderlies, the work from May 3 has been done with 10 +A.M.C. men and 30 men drawn from the patients. + +On June 17, 40 reinforcement A.M.C. men were detailed for duty. Up to +June 16 over 1,600 patients have been discharged. On May 23 the +Operating Theatre was opened. + +For the 1,600 patients we had six cooks with six natives to assist. + + T. F. BROWN, _Captain_, + _Officer in Charge, Luna Park_. + + HELIOPOLIS, + _June 17, 1915_. + +Of the 93 nurses belonging to the hospital, within a week of landing no +fewer than 47 were taken away and dispatched to various parts of Egypt, +viz.: + + Port Said (Clearing Hospital) 21 + Pont de Koubbeh (Egyptian Army H.) 9 + The Citadel (British Hospital) 6 + Alexandria 2 + Transport duty 8 + Returned to Australia (sick) 1 + __ + 47 + __ + +No. 1 Australian General Hospital was much inspected by keen and +curious, as well as sympathetic, eyes. His Highness the Sultan, Their +Excellencies Sir Henry and Lady MacMahon, the General Officer +Commanding-in-Chief, Egypt, the General Officer Commanding Australian +and New Zealand Army Corps, and many other distinguished people honoured +the hospital by an inspection. + +The following letters were written by three distinguished visitors. Two +Corps Orders are also attached. + + "SHEPHEARD'S HOTEL, CAIRO, + "_May 20, 1915_. + + "DEAR COLONEL RAMSAY SMITH, + +"Allow me to congratulate you upon the admirable medical arrangements at +Heliopolis, and upon the excellent hospital you have established there. +One is at first disposed to say, 'How well the building adapts itself to +a hospital!' until the true fact becomes revealed of the genius +displayed in converting a decidedly refractory building into a place for +the sick. You and your staff have done wonders and have once more shown +that in the land of Egypt 'it is possible to make bricks without straw.' + +"Australia may well be proud of the part she has played in this war, and +I can pay no higher compliment than by saying that the medical +arrangements of the Australian Army are as splendid as are the fighting +qualities of its men. + +"Above all I was impressed with the energy and enthusiasm with which the +work at Heliopolis is being carried on, with the ingenuity and resource +displayed at every turn, and with the thoroughness that was manifest in +every department of the vast hospital. + +"The generosity with which Australia has provided motor ambulances for +the whole country and Red Cross stores for every one, British or French, +who has been in want of same is beyond all words. + +"I only hope that the people of Australia will come to know of the +splendid manner in which their wounded have been cared for, and of the +noble and generous work which the great colony has done under the banner +of the Red Cross. + + "Yours sincerely, + "(Signed) FREDERICK TREVES." + +[Illustration: GORDON HOUSE, HELIOPOLIS (NURSES' HOME). +To _face page 200_]] + + "TURF CLUB, CAIRO, + "_June 21, 1915_ + + "DEAR COLONEL RAMSAY SMITH, + +"I am just off to the Dardanelles, and then back to Cairo, but I felt +that I must write and thank you for your kindness in sending me those +excellent and interesting photographs, which I shall treasure, and the +memory of the interesting day I spent with you at your wonderful +hospital. I also thank you for your report and for the copy of Sir F. +Treves's letter. + +"You must feel proud of your work at Heliopolis, on which I heartily +congratulate you. It is a monument of skill in administration and the +surmounting of what would at first appear to be insurmountable +difficulties. + +"Hoping soon to see you again, + + "Yours very sincerely, + "(Signed) A. W. MAYO-ROBSON." + + + "ST. MARK'S BUILDINGS, ALEXANDRIA, + "_June 5, 1915_. + + "DEAR MAJOR BARRETT, + +"I have been away at the front or I should have written to you sooner to +thank you for the interesting visit which you enabled Sir Frederick +Treves and myself to pay to your hospital and stores. I enclose an +extract of a report which I made on May 25 to the Hon. Arthur Stanley, +Chairman of the British Red Cross Society and Order of St. John in +London. + +"You may have noticed a minute published in the press with the approval +of the G.O.C., Sir John Maxwell, in which it was laid down that all Red +Cross work, except the Australian Red Cross work, should be under the +control of the British Red Cross and Order of St. John. I hope you will +not think that in drafting this minute in this way I wished to convey +that we were not working in perfect harmony with your Red Cross, but I +feel that we could hardly suggest to you that you should be in any way +under our control. At the same time, I hope that when you either come +here, or when I come back to Cairo, that we may have an opportunity of +conferring together so that we may so co-ordinate as far as possible our +mutual work. + +"May I add that I went to the Dardanelles in a transport with over a +thousand of your brave soldiers, many of whom were returning to the +Peninsula after having already been wounded. It is impossible to speak +too highly of their gallantry, and of the splendid spirit they +displayed. I need not tell you that I heard of their fighting qualities +at the front, since their heroic deeds in this campaign have already +become a matter of history. + + "Yours sincerely, + "(Signed) COURTAULD THOMSON, + + "_Chief Commissioner for British Red + Cross and Order of St. John, Malta, + Egypt, and Near East Commission._" + + + [_Copy_] + + EXTRACT FROM A REPORT FROM LIEUT.-COLONEL SIR COURTAULD THOMSON, + CHIEF COMMISSIONER OF THE BRITISH RED CROSS AND ORDER OF ST. + JOHN, TO THE HON. ARTHUR STANLEY, DATED MAY 25, 1915. + +"A striking feature in Cairo is the remarkable work which is being done +by the Australian Red Cross. They have not only two exceptionally large +hospitals and the large convalescent home, but they supply the motor +transport for the wounded for the whole of Egypt. They have also very +large Red Cross stores which they have brought with them. With these +articles they have been more than generous, and I am informed that they +have given away to the hospitals for our own troops something like 75 +per cent. of whatever they had." + + + EXTRACT FROM CORPS ORDERS, MARCH 28, 1915 + +"_Appreciation._--The D.M.S. Egypt, who visited the Hospital yesterday +afternoon, has requested the Officer Commanding to convey to the +officers, nurses, N.C.O.s, and men in the Hospital his appreciation of +the work done and the thorough character of the organisation." + + + EXTRACT FROM CORPS ORDERS, MAY 1, 1915 + +"_Appreciation._--The D.M.S. Egypt, Surgeon-General Ford, witnessed the +detraining of the invalids who arrived here Wednesday evening. He asked +Major Barrett to convey to the Officer Commanding his great appreciation +of the excellence of the arrangements and the efficient and quiet manner +in which the work was done. + +"He congratulates officers and men on the splendid work they are doing +and requests that it shall be communicated to them in Corps Orders." + +Looking back, does it not seem essential that these hospitals should +have been formed, at all events in outline, in time of peace? That their +commanding officers and essential staff should have been marked out +beforehand, so that on the declaration of war the gaps could have been +filled in from the reserve without difficulty? Satisfactory appointments +are much less likely to be made in the turmoil which follows the +declaration of war than in the atmosphere of deliberate calm which +prevails in time of peace. Had such an arrangement prevailed, the First +Australian General Hospital would certainly never have been recruited +from three States distant from one another hundreds of miles. + +Finally, Australian hospitals in time of war should either be regarded +as responsible solely to the Australian military authorities and +Government, or handed over without reserve to the R.A.M.C., and placed +entirely under the control of the British authorities. Where two +different authorities exist, as in the case of the First General +Hospital, a large amount of trouble and delay is almost certain to +ensue. The adoption of the latter course is in our judgment absolutely +essential if efficiency is to be secured. + +As is invariably the case, weaknesses in any system are only revealed by +costly experience. But while in the Australian Medical Service the +experience need not have been so costly, we can at least profit by what +has occurred, and frame a stronger and a better policy for the future. + +[Illustration: AUSTRALIAN CONVALESCENT HOSPITAL, AL HAYAT, HELOUAN. +_To face page 204_]] + +On the whole, the record of work done in most trying circumstances is, +we think, satisfactory. It is true that the universal democratic fault +was evidenced in the lack of preparation for conditions which were +fairly obvious. Nevertheless the adaptability and growth of the +hospitals in time of great emergency were achievements of the highest +order. + +Yet it would be unwise to leave the subject with the usual Anglo-Saxon +expression of satisfaction that the crisis was passed. The history +reviewed has too deep a significance. It must be regarded not merely as +an individual incident, but as an indication of the inefficiency +evidenced by too many departments of the Empire. + +The causes which found the medical services unprepared, which forced +them to expand to the breaking-point, and which led to the criticism of +the hospital authorities, are not departmental or sectional--they are +national. If attacks on individuals are permitted, initiative will be +stifled; if on the other hand we are content to follow the time-worn +policy of "muddling through," the virile people who skirt the border +lines of our Empire will sooner or later bid us make way for stronger +men. + +Our policy for the future must be one of scientific organisation and +calculated preparation in every department. We must not only appoint +capable administrators, but also trust them. We can again, if we like, +obtain that temporary mental tranquillity which comes to a +democracy--and to an ostrich--which does not or will not see the +calamity which threatens it, but temporary beatitude will be purchased +at the price of an Empire. Never was it more certainly true that the +price of liberty is eternal vigilance. + + + + + CHAPTER XI + + POSTSCRIPT + + CLOSURE OF AUSTRALIAN HOSPITALS--THE FLY CAMPAIGN--VENEREAL + DISEASES--Y.M.C.A. AND RED CROSS--MULTIPLICITY OF + FUNDS--PROPHYLAXIS--CONDITION OF RECRUITS ON ARRIVAL--HOSPITAL + ORGANISATION--THE HELP GIVEN BY ANGLO-EGYPTIANS. + + +One of us (J. W. B.) was invalided to England in the middle of November +1915, and returned to Egypt at the end of March 1916. + +He resigned his commission in the Australian Army Medical Corps on +February 28, and was appointed temporary Lt.-Col. in the R.A.M.C. on +February 29. On his return to Egypt he was appointed Consulting Aurist +to the Forces in Egypt, and was a member of the Council of the British +Red Cross Society and of the Y.M.C.A. He consequently had an opportunity +of witnessing the termination of many of the arrangements for which he +had been in part originally responsible, and desires to make brief +reference to them. + +No. 1 Australian General Hospital with its many off-shoots, including +the four auxiliary hospitals and the venereal disease hospital, was +located in Egypt for periods of twelve to eighteen months. No. 2 +Australian General Hospital was in Egypt about fourteen months. Yet it +was stated that each and every one of these hospitals when established +were to be temporarily located in Egypt for a few weeks. Luna Park, +_i.e._ No. 1 Auxiliary Hospital, was in existence approximately sixteen +months. An enormous number of sick and wounded, said to be 18,000, was +passed through it with an infinitesimal death-rate, viz. four or five +persons. Since the end of 1915, the No. 3 Australian General Hospital +was moved from Mudros to the Barracks at Abbassia, Cairo. The +expenditure necessary to fit the barracks for the reception of No. 3 +Australian General Hospital and the time taken are very interesting, +since they show how utterly impossible any such arrangement would have +been during the inrush of wounded in 1915. Stress is laid on the value +of auxiliary hospitals as the only practicable means of surmounting +difficulties at that time, in the report of the Committee of Inquiry +into the Administration of the Australian Branch British Red Cross in +Egypt. + +Looking back at the practical conclusion of the work of the Australian +Army Medical Corps in Egypt, it is quite evident that the policy +originally adopted was the only one possible in the circumstances, and +the results have fully justified it. + + +THE FLY CAMPAIGN + +Very active steps were taken during 1916 in the direction of a campaign +for the destruction of flies. The only addition that need be made to +previous remarks is reference to the ingenious fly traps which have been +devised. A large one was designed by Lt.-Col. Andrew Balfour, C.M.G., +and is described in the journal of the Army Medical Corps of July 1916. +A modified form of this trap, furnished by the British Red Cross in +Egypt, costs about 16_s._, and was most effective. These traps have been +known to catch as many as 20,000 flies a day. + +The smaller trap, which can be used indoors, and is made of zinc gauze, +was made in large quantities by the British Red Cross Society in +Alexandria, and distributed throughout Egypt. + +Another kind of trap, a Japanese invention, with clockwork mechanism, +manufactured by Owari Tokei, Kabushiki, Kwaisha, Japan, has also been +very successful. As many as 3,000 flies have been captured in one +instance in an hour. It has a considerable advantage over the other +traps in that its mechanism interests everyone. + +Like all fly traps, however, the utility of these devices depends upon +placing them in the hands of men whose business it is to see that they +are properly baited and cared for, and on some ingenuity with regard to +the baits. For the larger traps placed out-of-doors the best baits were +found to be fishes' heads or the entrails of fowls, whilst the best bait +for the smaller indoor trap was a mixture of beer or whisky and sugar. + +It is, of course, quite evident that the destruction of flies by traps +is not logically sound, since the proper method of control of the fly +pest is by the destruction of all refuse; but as that is impracticable +in Egypt, the traps were of great assistance. + +In 1916 the fly pest as usual became marked during two periods in the +year; viz. at the beginning and the end of summer. At the height of +summer the dryness and desiccation evidently prevent the breeding of +flies, a fact to be borne in mind in Australia. + +The returns given in the House of Commons respecting the Gallipoli +Campaign place the casualties at 116,000, and the cases invalided at +96,000. As a very large number of the cases of the sick were due to +intestinal infections, some idea of the damage which may be caused by +flies can be imagined. + +The discovery of bilharzia eggs and the organisms of dysentery and +diarrhoea in the fæces of flies made it clear that the fly plays an even +larger part in disseminating disease than has hitherto been understood. +It really would appear that if the flies were destroyed infective +diseases would fall to small proportions. + + +THE VENEREAL-DISEASE PROBLEM + +The venereal-disease problem in the early part of 1916 gave very great +concern, and active measures were taken to deal with it. In spite of all +the ameliorating influences the problem reached its most serious phase +in March and April 1916, as questions put in the House of Commons show +(_vide_ _Lancet_, April 8, 1916). I think I express the conviction of +certainly 90 per cent. of medical men in stating that nothing but +education and educated prophylaxis will ever enable us to get rid of +this source of destruction. + + +Y.M.C.A. AND RED CROSS + +The Soldiers' Club in the Ezbekieh Garden grew in favour and was +extended in area and staff. In the autumn of 1915 some ladies became +available, and did splendid service in the superintendence of the +catering for the men in the Club, and by their presence there did much +to help. + +A more extended experience of the work of the Y.M.C.A. and of the Red +Cross has given much cause for thought. The Y.M.C.A. organisation +appears to me to be excellent, since it is the organisation which caters +for the social welfare of the soldier, wherever he may be, whether in +camp or at the base; and the work is conducted by men whose business it +is to understand him and see that all reasonable wants are gratified. In +Egypt as I write (July 1916) there are no fewer than forty-seven +Y.M.C.A. huts and centres, and Y.M.C.A. officers in the desert, in the +oases, and elsewhere, doing their very best to make the soldiers +comfortable. In other words, the business of the Y.M.C.A. is to provide +comfort by personal service over and above military necessaries for the +men who are well. + +The Red Cross Society, on the other hand, attends to the wants of the +sick and wounded, and its functions have already been discussed. They +may, however, be supplemented by the following definition of the work of +the Red Cross which was furnished by the High Commissioner for Egypt, +Sir Henry MacMahon: + +"Government supplies all the necessities for the care, treatment, and +transport of the sick and wounded, while the Red Cross supplements these +necessities by everything that can in any way go to the comfort and +well-being of the sick and wounded soldiers. The distinction between +necessities and comforts is sometimes so indefinite that the Red Cross, +wherever possible, endeavours to have both ready to hand for use when +needed." + +And later: + +"A word must be said here about the work of the Red Cross Stores. The +object of the Red Cross has never been to supply in any large quantities +the goods which the War Office sends to the wounded, but it does its +best to provide the troops with such things as the War Office does not +supply at all or cannot supply at a given time. A State Department, +bound as it rightly is by hard-and-fast rules, cannot work as quickly as +a private body with more elastic regulations; moreover, the supplies of +any department may change at times, hence it happens that the British +Red Cross occasionally supply certain things more than the War Office +can, or it may supplement the War Office supplies, and it does so until +the War Office steps in again. Further, the Red Cross supplies many +things or small luxuries which the authorities cannot possibly supply, +and these are just the things which are most appreciated by the sick and +wounded." + +In other words, the function of the Red Cross is to assist over and +above necessity, and to be ready to act in event of emergency. + +The following lists of the Australian Branch and Egyptian Branch of the +British Red Cross show that in both cases, but particularly in the case +of the Australian Branch, the Red Cross is supplying articles which +should clearly be supplied by Government. There is considerable danger +in allowing this system to become too largely developed. In the first +place in the case of the Red Cross there is no rigid system of +accountancy such as military regulation requires, and the natural +tendency for commanders will be to get goods in the easiest possible +manner; nevertheless, it may not be the best thing for the service. + +The British Red Cross safeguards the practice more fully than the +younger branch, and its lead might well be followed. (See Lists on pp. +212-216.) + + +AUSTRALIAN BRANCH BRITISH RED CROSS SOCIETY + + LIST OF ARTICLES IN RED CROSS STORES WHICH MUST BE REQUISITIONED + FOR BY COMMANDING OFFICERS OF UNITS FOR THE CARE OF THE SICK AND + WOUNDED AND WHERE THERE IS NO RED CROSS STORE. + + 1916 + + _To the Commissioners, + Australian Branch British Red Cross Society, + Shepheard's Hotel, Cairo._ + + Please send to ---------------- the following articles: + + Quantity Description + + _Clothing_ + + Balaclava Caps + Cardigans + Cholera Belts + *Cushions, Air + * " Ordinary + Dressing Gowns + Facewashers + Fly Veils + Gloves + *Handkerchiefs + Mittens + *Mosquito Nets + Mufflers + *Pillows + *Pillow Slips + Pneumonia Jackets + *Pyjamas, Cotton + * " Flannel + *Quilts + *Sheets + *Shirts, Cotton + * " Flannel + * " Hospital + *Shoes, Deck + *Slippers, Hospital + *Socks + * " Bed + *Surgeons' Aprons + * " Caps + * " Gowns + * " Swabs + *Towels + * " Glass + Underpants, Cotton + " Flannel + Undershirts, Cotton + " Flannel + + _Foodstuffs_ + + Allenbury's Diet + " Food + Arrowroot + Beef Extract + Benger's Food + Biscuits + Bovril + Brandy + Ceregen + Chocolate + Cocoa + Cocoa-and-Milk + Coffee Essence + Coffee-and-Milk + Condensed Milk + Cornflour + Cornina + Fruits, Dried + " Tinned + Glaxo + Horlick's M. Milk + Jam + Jelly Crystals + Lactogen + Lime Juice + Linseed Meal + Malt Extract + Oatmeal + Pickles + Plum Puddings + Port Wine + Robinson's Barley + " Groats + Semolina + Soda Water + Sweets + Tapioca + Tinned Rabbits + " Tomatoes + " Tripe + " Vegetables + + _General_ + + *Absorbent Wool + *Bandages + *Bed Cradles + * " Rests + * " Screens + Books + *Brushes, Hair + * " Nail + * " Tooth + *Camp Stools + Cigarettes + *Combs + *Crutches + *Deck Chairs + Eau-de-Cologne + Envelopes + Fly Veils + Fly Whisks + Gramophone Needles + *Hospital Basins + *Hot-water Bottles + Housewives + *Insectibane + Looking-glasses + Matches + *Medicine Glasses + Old Linen + *Oil Heaters + Pencils + Periodicals + Pipes + *Primus Stoves + *Razors + *Razor Strops + *Rubber Sheeting + *Safety Pins + *Smoked Glasses + *Soap, Monkey Brand + *Soap, Shaving + * " Toilet + *Splints + *Sponges + *Tables, Folding + *Thermometers + Tobacco + *Toilet Paper + Tooth Paste + *Vaseline + Writing Pads + +_Note A._--As a general rule the Commissioners only supply goods that +cannot be obtained from either Ordnance Dept. Army Service Corps, or +Base Medical Depot Stores. Any O.C. requisitioning for goods of a kind +properly obtainable from those sources should state on the requisition +that the goods applied for cannot be obtained from the usual source. + +_Note B._--Regimental Medical Officers can obtain their requirements +from the O.C. of the nearest Field Ambulance, who will forward +requisitions to Red Cross. + + ---------------- + Officer in charge of Hospital. + +[All the articles marked * were permanent Government issues, and any of +the foodstuffs would have been supplied by Government if necessary. +There was no practical difficulty in obtaining any articles from +Government on proper application being made.] + + +BRITISH RED CROSS AND ORDER OF ST. JOHN + + _No. of Patients_ -------- _For the Use of Patients_ + + LIST OF ARTICLES IN RED CROSS STORES WHICH MAY BE + REQUISITIONED FOR. + + ---------------- 191 + + _To the Commissioner_, + _British Red Cross and Order of St. John_ + _Gresham Buildings, Cairo._ + + Please send to ---------------- + the following articles: + + Quantity Description + + B.D.M.S. Air Beds (Rubber) + Air Rings (Rubber) + B.D.M.S. Air Cushions (Rubber) + Ash Trays + Balaclava Helmets + B.D.M.S. Bandages + Bandage Winders + B.D.M.S. Bellows (for Air Beds) + O.D. Bed Pans + O.D. Bed Rests + O.D. Bed Trays + Bed Jackets + Bed Pockets + O.D. Blankets + Blacking + B.D.M.S. Boric Lint + Books and Magazines + Boot Brushes + A.S.C. Bovril + Biscuits + Brandy + O.D. Camp Stools + O.D. Caps + O.D. Cardigans + Carrying Chairs + Cholera Belts + Chocolate + A.S.C. Cigarettes + Cloths (Pantry and Kitchen) + O.D. Combs + B.D.M.S. Cotton Wool + B.D.M.S. Crutches + Dressing Gowns + Dressings + Deck Chairs + Eau-de-Cologne + Face Flannels + Face Nets + Fans + O.D. Fly Whisks + Fly Veils + Food Slicers + O.D. Feeding Cups + Games + B.D.M.S. Gauze Tissue + Goulas + Gramophones + Hair Brushes + O.D. Handkerchiefs + Head Shields + O.D. Hot-water Bottles and covers + B.D.M.S. Ice Bags + Jug Covers + Kit Bags + B.D.M.S. Linen (Old for Bandages) + A.S.C. Matches + Mirrors + O.D. Mosquito Netting + O.D. Mugs, Enamelled + O.D. Mufflers + Mittens + Nail Brushes + Nightingales + Officers' Outfits + Operation Stockings + O.D. Overalls + O.D. Pants + Pencils + Pipes + O.D. Pillows + O.D. Pillow Cases + Playing Cards + Pneumonia Jackets + Post Cards + O.D. Pyjamas + O.D. Razors + Razor Blades + Reading Matter + Rum + B.D.M.S. Rubber Gloves + O.D. Shaving Brushes + Soap (Toilet) + Spirits + Stationery + Sweets + Sun Hats + O.D. Shirts (Flannel) + " (Cotton) + " Helpless Case + " Helpless Case (Night) + O.D. Screens + O.D. Sheets + O.D. Socks + Sponges + O.D. Slippers + B.D.M.S. Swabs + Testaments + O.D. Tooth Brushes + Tooth Powder + A.S.C. Tobacco + O.D. Towels + O.D. Urinals + Vests + Walking Sticks + Whisky + Wool, Absorbent + B.D.M.S. Water Beds + B.D.M.S. Waterproof Sheeting (Pluviusin) + + _Extras_ + + + _Items marked_-- + _A.S.C._ (_Army Service Corps_), + _O.D._ (_Ordnance Dept._), + _B.D.M.S._ (_Base Depot Medical Stores_), + +will only be provided by the British Red Cross on the understanding +that the Military Departments have been applied to and cannot supply, or +that it is a case of grave or unexpected emergency. Such a demand to be +supported by signature of O.C. Hospital, which implies he has indented +on the department concerned and failed to obtain. + +_N.B._--_All indents to be countersigned by the O.C. Hospital._ + +The British Red Cross has definitely been placed under military control, +and the Chief Commissioner has been attached to the staff of the +Commander-in-Chief. The work goes on just as usual, but if necessity +arose the Commander-in-Chief could exercise his authority. + +I understand that in France the Australian Branch British Red Cross has +now been placed under military control; the Director of Medical +Services, Australian Expeditionary Force, being Chief Commissioner and +the other commissioners and officers being graded with various ranks. To +me this arrangement is definitely a step in the right direction, though +I still think the British system in Egypt is better. The officers of the +Red Cross in Egypt have no rank, but are under military direction, and +the Chief Civil Commissioner is attached to the staff of the +Commander-in-Chief; he has had the rank of Hon. Colonel since the war +began. It is interesting, however, to note that the Australian Branch +British Red Cross has passed through four phases, so far as the work in +the field is concerned: + +(1) It was a purely military organisation. + +(2) When the High Commissioner in Egypt was requested to form a +committee it became a combined civil and military organisation. + +(3) When the Australian commissioners were appointed it became a purely +civil administration. + +(4) It has finally become a combined civil and military organisation, in +which the military element holds control. + +This step further indicates the logical development, in my judgment, of +both the Y.M.C.A. and the Red Cross. They should both be regarded as +definite branches of the service. They should both be organised in time +of peace largely as independent organisations, and as part of the +Reserve, and, on declaration of war, they should be incorporated in the +service and placed under military control. The function of the one would +be to attend to the social wants of the men who are well, the other to +attend to the wants of the men who are sick and wounded. + +I do not think that any other funds or societies should be permitted to +interfere with military arrangements; all those who desire to help with +money, with goods, or with personal assistance could do so through the +one channel or the other. + +As a corollary to the foregoing it is evident that there should be only +one voluntary war fund, which should be placed under the control of a +committee representing the Y.M.C.A., the Red Cross, and nominees of the +Government and public, who could allocate the money subscribed to the +Y.M.C.A. or Red Cross as necessity arose. The following list shows the +unnecessary multiplicity of organisations and funds in the State of +Victoria alone, viz. at least seventeen societies in a community of +about one million and a half people. Even in Egypt enthusiastic people +started an "Australian Comforts Fund," a "Soldiers' Outings +Association," "Camp Welfare Association," and so forth, and these bodies +simply did for varying periods the work of the Y.M.C.A. or the Red +Cross as the case may be, in a more or less patchy way. + + +MULTIPLICITY OF FUNDS + + (_From "The Argus," Melbourne, 1916_) + + "WAR RELIEF FUNDS + "OBJECTS OUTLINED: A GUIDE TO GIVING + +"It is only when one sees the complete list of war relief funds compiled +by the State War Council, in connection with its announcement regarding +the supervision to be exercised over future collections, that the full +extent of the relief organisations and the wide scope covered by the +Victorian public's generous giving are appreciated. There are in +existence here a score of war funds of one kind or another, and by the +devoted efforts of their organisers and the warm-hearted support of the +public the lot of our soldiers has been brightened, the burden of pain +and suffering borne by the sick and wounded has been eased, a helping +hand has been extended to the homeless, broken sufferers of Belgium, +Poland, and Serbia, and a gleam of happiness brought to many a home in +France whose erstwhile bread-winner is on active service. + +"All the Victorian organisations have clearly defined objects, and are +working along sound lines. The list of funds is to be increased shortly +by the creation of a Repatriation Fund the details of which are now +being worked out. The money raised will be devoted to the settling in +suitable employment of soldiers who have fulfilled their service. A +similar object is aimed at in the repatriation scheme which has been +launched with such marked success by Mr. Rodgers, M.H.R. The objects of +the other funds, which have been and are doing so much, are thus +summarised for the information of the public by officials of the +organisations: + + "_British Red Cross Society_ + "(Australian Branch) + +"Objects officially stated as--'Red Cross work, to assist all hospitals +in time of war.' + + "_Victorian Red Cross Fund_ + +"For Australian sick and wounded soldiers (Lady Stanley Appeal). The +proceeds are being and will be remitted to the Australian Red Cross +Society, to be used by it for the benefit of Australian sick and wounded +soldiers and institutions in which they may be treated. + + "_Red Cross Society_ + "(Victorian Division) + +"Objects officially stated to be 'those of the Geneva Convention.' + + "_French Red Cross Society_ + +"The raising of funds for the work of the French Red Cross Society. + + "_Australian Patriotic Fund_ + +"For the benefit of Victorian soldiers and their dependents, soldiers +from any part of Australia and their dependents, other deserving objects +consequent on service at the war, and the augmenting of pensions granted +by the Commonwealth. + + "_State War Council's Fund_ + +"For discharged soldiers. Its object is to assist in re-establishing +discharged soldiers in employment. + + "_Commonwealth Button Fund_ + +"A collecting body, which has used its organisation for collecting for +various funds. It has collected for the Belgian Fund, Red Cross Society, +Lady Stanley's Appeal, French Red Cross, Serbian Fund, Italian Fund, +Russian Polish Fund, and for institutions at the front and in camps +belonging to the different churches and the Y.M.C.A. + + "_Lady Mayoress's Patriotic League_ + +"To assist in providing comforts, extra clothing, and foods for the +fighting men in the navy and army. + + "_Belgian Relief Fund_ + +"To assist in relieving distress in Belgium. + + "_Serbian Relief Fund_ + +"To assist in relieving distress amongst the Serbians. + + "_Polish Relief Fund_ + +"To assist in relieving distress amongst the Russian Poles. + + "_French Société Maternelle Fund_ + +"To collect funds for the Société d'Assistance Maternelle et Infantile. +The fund is administered in France, money and goods being collected here +and sent forward. + + "_Y.M.C.A. National Appeal_ + +"For the benefit of soldiers in camps, on troopships, and abroad, by +providing recreation, games, stationery, literature, and comforts, and +ministering generally to the moral and spiritual welfare of the +Australian troops. + + "_Commonwealth Service Patriotic Fund_ + +"Objects determined, as necessity arises, by a committee consisting of +heads of departments and branches. Allocations to different funds. + + "_State Service Patriotic Fund_ + +"Relief of distress resulting from the war. + + "_Education Department Patriotic Fund_ + +"Relief of distress caused by the war, and for providing clothing and +comforts for our troops. + + "_Railways Department Patriotic Fund_ + +"Relief of distress in Belgium, relief of distress due to unemployment +in Victoria, and Red Cross purposes in the proportion as nearly as +practicable of one-third to each." + +An additional advantage of the arrangements proposed would be that all +those who assist would be under a measure of discipline. Neither men nor +women helpers should be permitted to enter the war zone unless they +visit it with a serious purpose and an earnest desire to help. If they +enter in this frame of mind they will have no objection to submitting to +discipline. If they object it is far better for them to stay at home. + +It is furthermore apparent that Red Cross workers should be limited to +elderly men of experience or younger men who are physically defective. +In the case of the Y.M.C.A. young and healthy men are required, since +their work is very arduous, the living at times rough to a degree, and +there is not inconsiderable personal risk undertaken by those who are +placed in advanced positions. In national wars every healthy adult is +of great value as a soldier, and it is necessary to see that as few of +such men as possible are utilised in these auxiliary services. + +If the arrangements here indicated had been carried into effect, the +work in Egypt would have been much better done and the activities of the +Y.M.C.A. would have prevented a vast amount of trouble and disease. As +it was, the value of the Y.M.C.A. was not apparent to the public at +first, since its activities are not so dramatic as those of the Red +Cross Society, and funds have never been provided for it on anything +like the same scale. + +In conclusion, with regard to the Australian Branch British Red Cross, +there is something more to be said. As its name implies, the Australian +Red Cross is a branch of the British Red Cross Society, and yet we have +experienced in Egypt the spectacle of the Egyptian Branch and the +Australian Branch of the same society doing the same work for different +sections of troops engaged in a common cause. There were two Red Cross +stores in Cairo, Australian and British, two stores in Alexandria, and +two in Mudros. Would it not have been much better to amalgamate the two +branches and administer the Red Cross in Egypt as a whole? The +separation served no good material purpose, and whilst by the exercise +of good sense some of the difficulties arising from the dual arrangement +were obviated, yet this evidence of particularism was not advantageous. + +Vast quantities of goods were donated to the Australian Troops by the +Comforts Fund, and vast quantities of goods were given to soldiers in +hospitals and convalescent homes by the Australian Branch British Red +Cross. As evidence of soundness of heart on the part of the Australian +public this action was beyond praise, but it is doubtful whether the +methods were the best which might be devised. The generosity of the +public lent itself to some abuse, and soldiers are known to have sold +these goods to Arabs, and employed the cash as they pleased. It is +difficult to draw a healthy mean between strict administration with +proper restriction and lavish administration and abuse. It is doubtful +to me whether it would not better conserve the self-respect of the +soldier and be more dignified if these donations were to cease. In their +place proper facilities might well be substituted for the purchase of +such articles as the soldier required at very low prices. This is the +plan followed by the Y.M.C.A., who never divorce personal service from +any distribution of goods. If the pay of the Australian soldier--which +by the way is the highest in the world--is thought insufficient, it +could be increased by voluntary help conveyed through the proper +official channels. If this system were adopted it would necessitate the +appointment of a Y.M.C.A. and of a Red Cross officer to certain defined +military units, and a well-organised method would at once make its +appearance; in other words, we should substitute sympathetic order and +justice for amateurish enthusiasm. + +Does not the necessity for the foregoing criticism indicate our utter +unpreparedness? For if we had possessed a national organisation for +Peace and War, each and all of these problems would have been solved +long ago, and we should have been spared the spectacle of willing +helpers wasting their energy for lack of direction. + + +PREVENTION OF DISEASE + +Surveying the whole campaign, the fundamental fault of the Australian +Army Medical Service was the insufficient attention given to, and stress +laid on, the prevention of disease. Is it not obvious that there should +be a staff of medical officers and orderlies, detached altogether from +any association with the treatment of disease, who should devote +themselves entirely to the problem of prevention? This staff should be +presided over by a Surgeon-General who should be second only in rank to +the Director of Medical Services in the field, and who with his staff +should be armed with authority so far as the taking of steps for the +prevention of disease is concerned. At present the medical officers in +the Australian Medical Service are entrusted with dual functions, the +prevention and the treatment of disease. + +So far there has been no Military School for medical officers in +Australia, and until they are properly trained the prevention of disease +will not be as effective as it might be. + +In the Royal Army Medical Corps there is a Sanitary Staff, but it does +not seem to me that even this highly trained body occupies the high +position or enjoys the distinction that the value of its services really +demand, and I cannot but think that it would be far better to abolish +the term "sanitary" and to apply to it the term "Prophylactic Staff." + +The cure of disease in civil life always attracts the public; it is +dramatic and strikes the attention. The efforts of the men who obviate +the necessity for anything of the kind never receive the same +recognition, because the evil never becomes obvious. + + +CONDITIONS OF RECRUITS ON ARRIVAL + +Captain Lovegrove, A.A.M.C., was appointed Australian Embarkation +Officer at Suez whilst I was in charge. He has contributed the following +article to _The Australian Medical Journal_ relative to the work he did +during his ten months' stay. + + "MEDICAL NOTES ON TROOPS FROM AUSTRALIA LANDING AT SUEZ + + "BY FREDERICK LOVEGROVE, M.B., Ch.B.(_Melb._), _Captain + A.A.M.C., Australia_ + +"During ten months' tenure of the unique appointment of Australian +Embarkation Medical Officer, I have had peculiar opportunities of +observing the condition of our soldiers arriving in Egypt. + +"The physique of our men has always excited the admiration of the +British and Indian officers who have watched them disembark, and if an +excess of high spirits in the troops has occasionally given an +opportunity for military criticism, from a medical point of view this +sign of robust health is altogether satisfactory. + +"The time of the voyage to Egypt from Melbourne averages thirty days; +but, owing to delays at ports of call, many of the troops spend five +weeks or more on board ship. The fact that the death-rate is so low and +the condition of the men so good on arrival speaks highly for the +arrangements on the ships and the watchful care of the medical officers +on transport duty. A few accidents and an occasional case of +appendicitis form the bulk of the cases removed to general wards of Suez +Hospital. + +"Infectious disease, however, has occurred on a large number of vessels, +and it has been possible to form some opinion of the epidemics present +in the various camps in Australia, by noting the prevalent type of +infectious disease on ships from different States. + +"(1) Influenza has been far and away the most common complaint. Though +some of the patients are still febrile on arrival, and are sent to +hospital here, the epidemic is usually spent before Egypt is reached. + +"(2) Pneumonia is occasionally severe, and is usually associated with an +epidemic of influenza. Twelve months ago a certain percentage of cases +developed empyema; for many months now there have been no cases of this +kind. + +"(3) Measles has been chiefly found among Victorian troops, and has been +represented every month. South Australia has sent its quota during April +and May. In some cases the epidemic has been wide-spread at first, and +has worked itself out before arrival. In other cases a few men have been +picked out early and isolated, and no epidemic has occurred. +Occasionally a ship has arrived with a large number of cases, evidently +originating after embarkation from some unrecognised case on board. + +"(4) Mumps has been represented largely every month. This disease is +practically a perquisite of New South Wales and Queensland troops. The +long incubation period and impossibility of recognising the disease in +an early stage makes a general ship infection the rule, and the +epidemic is usually at its height when the troops arrive here. + +"(5) Cerebro-spinal meningitis has not occurred as an epidemic, but has +appeared on the returns every month, with one or two cases. Victoria has +contributed the largest number of cases, except in November and January, +when New South Wales supplied the largest number. Victoria has had a +monopoly for the past four months. + +"(6) Enteric fever has been remarkable by its rarity. Ten cases only +have been noted; of which New South Wales contributed six, five from one +ship; Victoria one in each of the months of September, November, and +December; and South Australia one in December. No cases have occurred +this year. + +"Chicken-pox, scarlet fever, and roetheln have occasioned no trouble +here. Small-pox, plague, or cholera have not occurred among troops on +Australian transports. + +"(7) Venereal disease. While the percentage of troops arriving in Egypt +with venereal disease is not high--the actual figure is 0·75 per +cent.--the total number of effectives withdrawn from combatant duty +owing to this cause is sufficiently large to make the subject one of +importance. In ten months 530 men with gonorrhoea and 90 men with +syphilis have had to go to hospital immediately on arrival. Soft sores +have almost always been cured on the voyage, so that practically all +chancres seen here are syphilitic. By far the greatest number of +syphilitic cases hail from Queensland and New South Wales, and while +gonorrhoea is the main feature of Victorian venereal cases, the two +previously mentioned States take the precedence here also. A rise in +the numbers from Western Australia has lately been noticed. This may +possibly be due to the fact that men from other States found to be +suffering from venereal diseases while crossing the Bight are landed in +Western Australia. There is a general rise in the proportion of syphilis +to gonorrhoea, and this is particularly noticeable among Queensland +troops, where the general ratio of one syphilis to six gonorrhoea is now +more like one to one, and occasionally the cases of gonorrhoea are +outnumbered by syphilis." + + +HOSPITAL ORGANISATION + +With extended experience the views of the writer on the subject of the +organisation of military hospitals have crystallised. There is no doubt +that the commander of a hospital must be a medical practitioner, and +there is no doubt that in all matters relating to his hospital his +authority must be final. In the last resort he must decide whether a +patient is to leave the hospital or to stay; who should be admitted, and +what the treatment should be. In a good organisation he will probably be +very rarely required to express an opinion respecting these matters, but +in the event of a conflict of opinion between say the consulting surgeon +or physician and himself, there can be but one final arbitrament. The +position is defined in the King's Regulations and is endorsed by common +sense. So far as the Registrar is concerned I think that he should be a +medical practitioner, but that in every instance there should be an +assistant registrar with the rank of lieutenant, who should do the whole +of the detailed work connected with the records, and who need not +necessarily be a medical officer. In like manner, the Transport Officer +and the Orderly Officer or Adjutant should be of the same character and +rank. Difficulty, however, arises respecting the personnel of these +non-medical offices. It is clear that, for purposes of discipline, they +should belong to the Army Medical Corps and be under the control of the +officer commanding. In time of war there is no doubt that invalided +combatant officers would do very well, but no combatant officer would +want such a position in time of peace, because there would be no +subsequent career available. To effect a satisfactory solution of the +problem it would be necessary to add to the establishment of a base +hospital three non-medical commissioned officers of the same rank as the +Quartermaster, preferably former Sergt.-Majors who have obtained +commissions and who consequently know the details of hospital +administration thoroughly. There would then be in each base hospital +four non-medical commissioned officers, viz. the Quartermaster, the +Asst. Registrar, the Orderly Officer, and the Transport Officer, and all +would belong to the A.M.C. A hospital suitably staffed on this plan +would run very smoothly. + + +ASSISTANCE OF ANGLO-EGYPTIANS + +Surveying the work of the Australian Army Medical Corps in Egypt, it +does seem to me that sufficient acknowledgment has not been made of the +services rendered and the help given to the Australian sick and wounded +by the British residents in Egypt, who, from their Excellencies Sir +Henry and Lady MacMahon downwards, spared no effort to help wherever +assistance was possible. Very many of the officials employed in the +Egyptian Government service came to the hospitals when the day's work +was over and worked till late in the night, rendering services which +freed the orderlies for other special duty. It was impossible to get +reinforcements with any rapidity, the pressure was enormous, and the +least that can be said is that these ladies and gentlemen are entitled +to respectful and grateful acknowledgment from the people of Australia. + +Special acknowledgment also should be made of the sympathetic help given +by the courteous and able officers of the Egyptian State Railways. + +I do not think it will be right to close the work without personal +acknowledgment of the exceedingly valuable help given in a time of +crisis by the ladies and gentlemen whose names are attached, and who, at +great inconvenience, came forward at the time when other help was +unobtainable. + + +No. 1 AUSTRALIAN GENERAL HOSPITAL--HELIOPOLIS PALACE + + From its establishment until the opening of No. 2 General Hospital + + _Principal Red Cross Visitor_ + Mrs. Elgood + + _Ward Visitors (daily or several times a week)_ + + Lady Oakes + Mrs. Abramson + Mrs. Blakeney + Mrs. Frank Watson + Mrs. Boys + Mrs. Madden + Lady Brunyate + Mrs. Perels + Mrs. Dale + Mrs. Mackworth + The Hon. Mrs. Home + Lady Cheetham + Mrs. Everett + Miss Devonshire + Mrs. Teal + Lady Douglas + Mrs. Paxton + Mrs. Fletcher + Mrs. Dunhill + + Most valuable assistance was also rendered by Mrs. Travers + Symons and Mrs. W. Jessop. + + _Flower Ladies (visiting three times a week)_ + + Mrs. Hodgson + Mrs. Spong + Miss Marshall + Mrs. Crawley + Mrs. Garrett + Mrs. Spencer Smith + Mrs. Lumley Smith + + +HELIOPOLIS + + From the opening of the No. 2 General Hospital, till end of July + 1915 + + _Principal Visitor_ + Mrs. Elgood + + _Ward Visitors (daily or several times a week)_ + + Lady Oakes + Mrs. Waller + Mrs. Sender + Mrs. Fox + Mrs. Summons + Mrs. Maxwell + Miss Mavris + Mr. Dulle + Mr. Schreiber + Major Blakeney + Mrs. Blakeney + Mrs. MacDonald + Mrs. Everett + Mrs. H. Chisholme + The Hon. Mrs. Home + Mrs. Perels + Mrs. Dale + Mrs. Fletcher + Mrs. Spencer Smith + Mrs. Dawnay + Mrs. and Miss Knox + Mrs. and the Misses Spens + Three Ladies from C.M.S. + Mme. and Mlle. de Lancker + Mme. de Rey + Mrs. Dunbar Brunton + Miss Hanauer + Mrs. Watson + Mr. St. Clair + Dr. Grace Russell + Mrs. Adie + Mrs. Wisdom + Mrs. Makeham + Mrs. Bruce + + _Organiser of Concerts_ + The Countess de Lavison + + +NO. 1 AUSTRALIAN GENERAL HOSPITAL + + _Gentlemen who did Telephone Duty at Heliopolis Palace_ + + Mr. H. O. Bennett, Kubba Gardens + Mr. G. Brackenbury, late of Palais de Kubba + Mr. L. Billson, Zeitoun + Mr. N. L. Ablett, Helmieh + Mr. A. Abramson, late of Heliopolis + Mr. T. H. Clarke, Zeitoun + Mr. G. R. Tadman, late of Heliopolis + Mr. H. B. May, late of Zeitoun + Mr. A. R. B. Milton, Heliopolis + Mr. S. Fraser, Heliopolis + Mr. R. Lawson, Heliopolis + Mr. M. R. Pattison, Zeitoun + Mr. G. Muller, Kafr el Gamous + Mr. H. E. Gardiner, Kafr el Gamous + Mr. E. Griffith Jones, Mataria + Mr. J. C. Mansfield, Kubba les Bains + Mr. J. K. Parkes, late of Heliopolis + Mr. Hanauer (Senr.), late of Heliopolis + + +LUNA PARK--SKATING RINK + + From opening till middle of July 1915 + + _Principal Visitor_ + Lady Oakes + + _Ward Visitors (daily or several times a week)_ + + Mrs. Spencer Smith + Mrs. Elgood + Mrs. H. Chisholme + Miss Griffiths + Mrs. Wellburn + Mrs. Barry Davies + The Misses Crewe (2) + Mrs. Woodifield + Mrs. Clogstoun + Mrs. Mackworth + Major Blakeney + Mrs. Teasdale Smith + Mrs. Rebett + Miss Christian + Mrs. Knox + Mrs. Parlato + Mme. Yenidimia + Mrs. Bailey + Mrs. Everett + Mrs. Williams + Mr. Blythe + Mrs. Makeham + Mrs. Bruce + Mr. Naggiar + Mr. Airlet + Mrs. Fenwick + + _Daily Ward Workers_ + + Miss Villedieu + Mrs. Addison + Miss Ratzkowski + Mrs. Le Fleming + Mrs. Murray + The Hon. Mrs. Morrison Bell + Mrs. Hibbert + Mrs. and Miss Leathes + Mrs. Sender + Mrs. Walker + Mrs. Fox + Miss Morrison + Miss Pound + Mrs. Wilson + Mlle. Picciotti + Mrs. Fanous + + +LUNA PARK PAVILION + + _Principal Visitor_ + Mr. Blythe + + _Helpers_ + + Mr. and Mrs. May, late of Zeitoun + Mr. and Mrs. Bennett, Kubba Gardens + Mr. and Mrs. Micklam, Palais Kubba + Mr. and Mrs. Stopford, Zeitoun + Mr. and Mrs. Ablett, Helmieh + Mr. and Mrs. Levy, Heliopolis + Mr. and Mrs. Hood, late of Kubba Gardens + Mr. and Mrs. Clarke, now at Kubba les Bains + Mrs. T. and Miss Williams, Zeitoun + Mrs. Watkins, late of Zeitoun + Mrs. Hogan, late of Zeitoun + Mrs. Fenwick, Helmieh + Mrs. Tite, Zeitoun + Mr. Goadby, late of Zeitoun + Mr. Brackenbury, late of Palais Kubba + Mr. Poths, now at Kubba les Bains + + +ATELIER + + _Principal Visitor_ + Mr. Goadby + + _Daily Workers_ + + Mrs. Goadby + Mrs. and the Misses Spens + Mrs. Dawnay (_Librarian_) + Mrs. Morris + + +SPORTING CLUB + + _Principal Visitor_ + Mr. Herbert + + _Daily Worker_ + Mrs. Eddy (after Nov. 1916) + + [The first Inquiry Bureau in Egypt for service in connection + with the Wounded and Missing was established by Mrs. Jessop, of + the Y.M.C.A.] + + + + +APPENDIXES + + + APPENDIX I: TRANSLATION OF GENEVA CONVENTION OF JULY 6, 1906 + + APPENDIX II: CONVENTION FOR THE ADAPTATION OF THE PRINCIPLES OF + THE GENEVA CONVENTION TO MARITIME WAR + + + + + APPENDIX I + + CHAPTER I + THE WOUNDED AND SICK + + +_Article 1_ + +Officers and soldiers, and other persons officially attached to armies, +shall be respected and taken care of when wounded or sick by the +belligerent in whose power they may be, without distinction of +nationality. + +Nevertheless, a belligerent who is compelled to abandon sick or wounded +to the enemy shall, as far as military exigencies permit, leave with +them a portion of his medical _personnel_ and material to contribute to +the care of them. + +_Article 2_ + +Except as regards the treatment to be provided for them in virtue of the +preceding article, the wounded and sick of an army who fall into the +hands of an enemy are prisoners of war, and the general provisions of +international law concerning prisoners are applicable to them. + +Belligerents are, however, free to arrange with one another such +exceptions and mitigations with reference to sick and wounded prisoners +as they may judge expedient; in particular, they will be at liberty to +agree-- + +To restore to one another the wounded left on the field after a battle; + +To repatriate any wounded and sick whom they do not wish to retain as +prisoners, after rendering them fit for removal or after recovery; + +To hand over to a neutral State, with the latter's consent, the enemy's +wounded and sick to be interned by the neutral State until the end of +hostilities. + +_Article 3_ + +After each engagement the Commander in possession of the field shall +take measures to search for the wounded, and to ensure protection +against pillage and maltreatment both for the wounded and for the dead. + +He shall arrange that a careful examination of the bodies is made before +the dead are buried or cremated. + +_Article 4_ + +As early as possible each belligerent shall send to the authorities of +the country or army to which they belong the military identification +marks or tokens found on the dead, and a nominal roll of the wounded or +sick who have been collected by him. + +The belligerents shall keep each other mutually informed of any +internments and changes, as well as of admissions into hospital and +deaths among the wounded and sick in their hands. They shall collect all +the articles of personal use, valuables, letters, etc., which are found +on the field of battle or left by the wounded or sick who have died in +the medical establishments or units, in order that such objects may be +transmitted to the persons interested by the authorities of their own +country. + +_Article 5_ + +The competent military authority may appeal to the charitable zeal of +the inhabitants to collect and take care of, under his direction, the +wounded or sick of armies, granting to those who respond to the appeal +special protection and certain immunities. + + + CHAPTER II + Medical Units and Establishments + + +_Article 6_ + +Mobile medical units (that is to say, those which are intended to +accompany armies into the field) and the fixed establishments of the +medical service shall be respected and protected by the belligerents. + +_Article 7_ + +The protection to which medical units and establishments are entitled +ceases if they are made use of to commit acts harmful to the enemy. + +_Article 8_ + +The following facts are not considered to be of a nature to deprive a +medical unit or establishment of the protection guaranteed by Article +6:-- + +1. That the _personnel_ of the unit or of the establishment is armed, +and that it uses its arms for its own defence or for that of the sick +and wounded under its charge. + +2. That in default of armed orderlies the unit or establishment is +guarded by a picquet or by sentinels furnished with an authority in due +form. + +3. That weapons and cartridges taken from the wounded and not yet handed +over to the proper department are found in the unit or establishment. + + + CHAPTER III + PERSONNEL + + +_Article 9_ + +The _personnel_ engaged exclusively in the collection, transport, and +treatment of the wounded and the sick, as well as in the administration +of medical units and establishments, and the Chaplains attached to +armies, shall be respected and protected under all circumstances. If +they fall into the hands of the enemy they shall not be treated as +prisoners of war. + +These provisions apply to the guard of medical units and establishments +under the circumstances indicated in Article 8 (2). + +_Article 10_ + +The _personnel_ of Voluntary Aid Societies, duly recognised and +authorised by their Government, who may be employed in the medical units +and establishments of armies, is placed on the same footing as the +_personnel_ referred to in the preceding article, provided always that +the first-mentioned _personnel_ shall be subject to military law and +regulations. + +Each State shall notify to the other, either in time of peace or at the +commencement of or during the course of hostilities, but in every case +before actually employing them, the names of the societies which it has +authorised, under its responsibility, to render assistance to the +regular medical service of its armies. + +_Article 11_ + +A recognised society of a neutral country can only afford the assistance +of its medical _personnel_ and units to a belligerent with the previous +consent of its own Government and the authorisation of the belligerent +concerned. + +A belligerent who accepts such assistance is bound to notify the fact to +his adversary before making any use of it. + +_Article 12_ + +The persons designated in Articles 9, 10, and 11, after they have fallen +into the hands of the enemy, shall continue to carry on their duties +under his direction. + +When their assistance is no longer indispensable, they shall be sent +back to their army or to their country at such time and by such route as +may be compatible with military exigencies. + +They shall then take with them such effects, instruments, arms, and +horses as are their private property. + +_Article 13_ + +The enemy shall secure to the persons mentioned in Article 9, while in +his hands, the same allowances and the same pay as are granted to the +persons holding the same rank in his own army. + + + CHAPTER IV + MATERIAL + + +_Article 14_ + +If mobile medical units fall into the hands of the enemy they shall +retain their material, including their teams, irrespectively of the +means of transport and the drivers employed. + +Nevertheless, the competent military authority shall be free to use the +material for the treatment of the wounded and sick. It shall be restored +under the conditions laid down for the medical _personnel_, and so far +as possible at the same time. + +_Article 15_ + +The buildings and material of fixed establishments remain subject to the +laws of war, but may not be diverted from their purpose so long as they +are necessary for the wounded and the sick. + +Nevertheless, the Commanders of troops in the field may dispose of them, +in case of urgent military necessity, provided they make previous +arrangements for the welfare of the wounded and sick who are found +there. + +_Article 16_ + +The material of Voluntary Aid Societies which are admitted to the +privileges of the Convention under the conditions laid down therein is +considered private property, and as such to be respected under all +circumstances, saving only the right of requisition recognised for +belligerents in accordance with the laws and customs of war. + + + CHAPTER V + CONVOYS OF EVACUATION + + +_Article 17_ + +Convoys of evacuation shall be treated like mobile medical units subject +to the following special provisions:-- + +1. A belligerent intercepting a convoy may break it up if military +exigencies demand, provided he takes charge of the sick and wounded who +are in it. + +2. In this case, the obligation to send back the medical _personnel_, +provided for in Article 12, shall be extended to the whole of the +military _personnel_ detailed for the transport or the protection of the +convoy, and furnished with an authority in due form to that effect. + +The obligation to restore the medical material, provided for in Article +14, shall apply to railway trains, and boats used in internal +navigation, which are specially arranged for evacuations, as well as to +the material belonging to the medical service for fitting up ordinary +vehicles, trains, and boats. + +Military vehicles other than those of the medical service may be +captured with their teams. + +The civilian _personnel_ and the various means of transport obtained by +requisition, including railway material and boats used for convoys, +shall be subject to the general rules of international law. + + + CHAPTER VI + THE DISTINCTIVE EMBLEM + + +_Article 18_ + +As a compliment to Switzerland, the heraldic emblem of the red cross on +a white ground, formed by reversing the Federal colours, is retained as +the emblem and distinctive sign of the medical service of armies. + +_Article 19_ + +With the permission of the competent military authority, this emblem +shall be shown on the flags and armlets (_brassards_), as well as on all +the material belonging to the Medical Service. + +_Article 20_ + +The _personnel_ protected in pursuance of Articles 9 (paragraph 1), 10, +and 11 shall wear, fixed to the left arm, an armlet (_brassard_), with a +red cross on a white ground, delivered and stamped by the competent +military authority, and accompanied by a certificate of identity in the +case of persons who are attached to the medical service of armies, but +who have not a military uniform. + +_Article 21_ + +The distinctive flag of the Convention shall only be hoisted over those +medical units and establishments which are entitled to be respected +under the Convention, and with the consent of the military authorities. +It must be accompanied by the national flag of the belligerent to whom +the unit or establishment belongs. + +Nevertheless, medical units which have fallen into the hands of the +enemy, so long as they are in that situation, shall not fly any other +flag than that of the Red Cross. + +_Article 22_ + +The medical units belonging to neutral countries which may be authorised +to afford their services under the conditions laid down in Article 11 +shall fly, along with the flag of the Convention, the national flag of +the belligerent to whose army they are attached. + +The provisions of the second paragraph of the preceding article are +applicable to them. + +_Article 23_ + +The emblem of the red cross on a white ground and the words "Red Cross" +or "Geneva Cross" shall not be used either in time of peace or in time +of war, except to protect or to indicate the medical units and +establishments and the _personnel_ and material protected by the +Convention. + + + CHAPTER VII + APPLICATION AND CARRYING OUT OF THE CONVENTION + + +_Article 24_ + +The provisions of the present Convention are only binding upon the +Contracting Powers in the case of war between two or more of them. These +provisions shall cease to be binding from the moment when one of the +belligerent Powers is not a party to the Convention. + +_Article 25_ + +The Commanders-in-chief of belligerent armies shall arrange the details +for carrying out the preceding articles, as well as for cases not +provided for, in accordance with the instructions of their respective +Governments, and in conformity with the general principles of the +present Convention. + +_Article 26_ + +The Signatory Governments will take the necessary measures to instruct +their troops, especially the _personnel_ protected, in the provisions of +the present Convention, and to bring them to the notice of the civil +population. + + + CHAPTER VIII + PREVENTION OF ABUSES AND INFRACTIONS + + +_Article 27_ + +The Signatory Governments, in countries the legislation of which is not +at present adequate for the purpose, undertake to adopt or to propose to +their legislative bodies such measures as may be necessary to prevent at +all times the employment of the emblem or the name of Red Cross or +Geneva Cross by private individuals or by societies other than those +which are entitled to do so under the present Convention, and in +particular for commercial purposes as a trade-mark or trading mark. + +The prohibition of the employment of the emblem or the names in question +shall come into operation from the date fixed by each legislature, and +at the latest five years after the present Convention comes into force. +From that date it shall no longer be lawful to adopt a trade-mark or +trading mark contrary to this prohibition. + +_Article 28_ + +The Signatory Governments also undertake to adopt, or to propose to +their legislative bodies, should their military law be insufficient for +the purpose, the measures necessary for the repression in time of war of +individual acts of pillage and maltreatment of the wounded and sick of +armies, as well as for the punishment, as an unlawful employment of +military insignia, of the improper use of the Red Cross flag and armlet +(_brassard_) by officers and soldiers or private individuals not +protected by the present Convention. + +They shall communicate to one another, through the Swiss Federal +Council, the provisions relative to these measures of repression at the +latest within five years from the ratification of the present +Convention. + + + GENERAL PROVISIONS + + +_Article 29_ + +The present Convention shall be ratified as soon as possible. The +ratifications shall be deposited at Berne. + +When each ratification is deposited a _procès verbal_ shall be drawn up, +and a copy thereof certified as correct shall be forwarded through the +diplomatic channel to all the Contracting Powers. + +_Article 30_ + +The present Convention shall come into force for each Power six months +after the date of the deposit of its ratification. + +_Article 31_ + +The present Convention, duly ratified, shall replace the Convention of +August 22nd, 1864, in relations between the Contracting States. The +Convention of 1864 remains in force between such of the parties who +signed it who may not likewise ratify the present Convention. + +_Article 32_ + +The present Convention may be signed until December 31st next by the +Powers represented at the Conference, which was opened at Geneva on June +11, 1906, as also by the Powers, not represented at that Conference, +which signed the Convention of 1864. + +Such of the aforesaid Powers as shall have not signed the present +Convention by December 31st, 1906, shall remain free to accede to it +subsequently. They shall notify their accession by means of a written +communication addressed to the Swiss Federal Council, and communicated +by the latter to all the Contracting Powers. + +Other Powers may apply to accede in the same manner, but their request +shall only take effect if within a period of one year from the +notification of it to the Federal Council no objection to it reaches the +Council from any of the Contracting Powers. + +_Article 33_ + +Each of the Contracting Powers shall be at liberty to denounce the +present Convention. The denunciation shall not take effect until one +year after the written notification of it has reached the Swiss Federal +Council. The Council shall immediately communicate the notification to +all the other Contracting Parties. + +The denunciation shall only affect the Power which has notified it. + + + + + APPENDIX II + +His Majesty the German Emperor, King of Prussia; the President of the +United States of America; the President of the Argentine Republic; His +Majesty the Emperor of Austria, King of Bohemia, etc., and Apostolic +King of Hungary; His Majesty the King of the Belgians; the President of +the Republic of Bolivia; the President of the Republic of the United +States of Brazil; His Royal Highness the Prince of Bulgaria; the +President of the Republic of Chile; His Majesty the Emperor of China; +the President of the Republic of Colombia; the Provisional Governor of +the Republic of Cuba; His Majesty the King of Denmark; the President of +the Dominican Republic; the President of the Republic of Ecuador; His +Majesty the King of Spain; the President of the French Republic; His +Majesty the King of the United Kingdom of Great Britain and Ireland and +of the British Dominions beyond the Seas, Emperor of India; His Majesty +the King of the Hellenes; the President of the Republic of Guatemala; +the President of the Republic of Haiti; His Majesty the King of Italy; +His Majesty the Emperor of Japan; His Royal Highness the Grand Duke of +Luxemburg, Duke of Nassau; the President of the United States of Mexico; +His Royal Highness the Prince of Montenegro; the President of the +Republic of Nicaragua; His Majesty the King of Norway; the President of +the Republic of Panama; the President of the Republic of Paraguay; Her +Majesty the Queen of the Netherlands; the President of the Republic of +Peru; His Imperial Majesty the Shah of Persia; His Majesty the King of +Portugal and of the Algarves, etc.; His Majesty the King of Roumania; +His Majesty the Emperor of All the Russias; the President of the +Republic of Salvador; His Majesty the King of Serbia; His Majesty the +King of Siam; His Majesty the King of Sweden; the Swiss Federal Council; +His Majesty the Emperor of the Ottomans; the President of the Oriental +Republic of Uruguay; the President of the United States of Venezuela: + +Animated alike by the desire to diminish, as far as depends on them, the +inevitable evils of war; and + +Wishing with this object to adapt to maritime war the principles of the +Geneva Convention of July 6, 1906: + +Have resolved to conclude a Convention for the purpose of revising the +Convention of July 29, 1899, relative to this question, and have +appointed as their Plenipotentiaries, that is to say: + +[Names of Plenipotentiaries.] + +Who, after having deposited their full powers, found to be in good and +due form, have agreed upon the following provisions:-- + +_Article 1_ + +Military hospital-ships, that is to say, ships constructed or adapted by +States for the particular and sole purpose of aiding the sick, wounded, +and shipwrecked, the names of which have been communicated to the +belligerent Powers at the commencement or during the course of +hostilities, and in any case before they are employed, shall be +respected, and may not be captured while hostilities last. + +Such ships, moreover, are not on the same footing as war-ships as +regards their stay in a neutral port. + +_Article 2_ + +Hospital-ships, equipped wholly or in part at the expense of private +individuals or officially recognised relief societies, shall likewise be +respected and exempt from capture, if the belligerent Power to which +they belong has given them an official commission and has notified their +names to the hostile Power at the commencement of or during hostilities, +and in any case before they are employed. + +Such ships shall be provided with a certificate from the proper +authorities declaring that the vessels have been under their control +while fitting out and on final departure. + +_Article 3_ + +Hospital-ships, equipped wholly or in part at the expense of private +individuals or officially recognised societies of neutral countries, +shall be respected and exempt from capture, on condition that they are +placed under the orders of one of the belligerents, with the previous +consent of their own Government and with the authorisation of the +belligerent himself, and on condition also that the latter has notified +their name to his adversary at the commencement of or during +hostilities, and in any case before they are employed. + +_Article 4_ + +The ships mentioned in Articles 1, 2, and 3 shall afford relief and +assistance to the wounded, sick, and shipwrecked of the belligerents +without distinction of nationality. + +The Governments undertake not to use these ships for any military +purpose. + +Such vessels must in no wise hamper the movements of the combatants. + +During and after an engagement they will act at their own risk and +peril. + +The belligerents shall have the right to control and search them; they +may refuse to help them, order them off, make them take a certain +course, and put a Commissioner on board; they may even detain them, if +the situation is such as to require it. + +The belligerents shall, as far as possible, enter in the log of the +hospital-ships the orders which they give them. + +_Article 5_ + +Military hospital-ships shall be distinguished by being painted white +outside with a horizontal band of green about a metre and a half in +breadth. + +The ships mentioned in Articles 2 and 3 shall be distinguished by being +painted white outside with a horizontal band of red about a metre and a +half in breadth. + +The boats of the said ships, as also small craft which may be used for +hospital work, shall be distinguished by similar painting. + +All hospital-ships shall make themselves known by hoisting, with their +national flag, the white flag with a red cross provided by the Geneva +Convention, and further, if they belong to a neutral State, by flying +at the mainmast the national flag of the belligerent under whose orders +they are placed. + +Hospital-ships which are detained under Article 4 by the enemy must haul +down the national flag of the belligerent to whom they belong. + +The ships and boats above mentioned which wish to ensure by night the +freedom from interference to which they are entitled, must, subject to +the assent of the belligerent they are accompanying, take the necessary +measures to render their special painting sufficiently plain. + +_Article 6_ + +The distinguishing signs referred to in Article 5 shall only be used, +whether in peace or war, for protecting or indicating the ships therein +mentioned. + +_Article 7_ + +In the case of a fight on board a war-ship, the sick-bays shall be +respected and spared as far as possible. + +The said sick-bays and the _matériel_ belonging to them remain subject +to the laws of war; they cannot, however, be used for any purpose other +than that for which they were originally intended, so long as they are +required for the sick and wounded. + +The commander into whose power they have fallen may, however, if the +military situation requires it, apply them to other purposes, after +seeing that the sick and wounded on board are properly provided for. + +_Article 8_ + +Hospital-ships and sick-bays of vessels are no longer entitled to +protection if they are employed for the purpose of injuring the enemy. + +The fact of the staff of the said ships and sick-bays being armed for +maintaining order and for defending the sick and wounded, and the +presence of wireless telegraphy apparatus on board, are not sufficient +reasons for withdrawing protection. + +_Article 9_ + +Belligerents may appeal to the charity of the commanders of neutral +merchant-ships, yachts, or boats to take the sick and wounded on board +and tend them. + +Vessels responding to this appeal, and also vessels which may have of +their own accord rescued sick, wounded, or shipwrecked men, shall enjoy +special protection and certain immunities. In no case may they be +captured for the sole reason of having such persons on board; but, +subject to any undertaking that may have been given to them, they remain +liable to capture for any violations of neutrality they may have +committed. + +_Article 10_ + +The religious, medical, and hospital staff of any captured ship is +inviolable, and its members may not be made prisoners of war. On leaving +the ship they are entitled to remove their own private belongings and +surgical instruments. + +They shall continue to discharge their duties so far as necessary, and +can afterwards leave, when the Commander-in-Chief considers it +permissible. + +Belligerents must guarantee to the said staff, while in their hands, the +same allowances and pay as are given to the staff of corresponding rank +in their own navy. + +_Article 11_ + +Sick or wounded sailors, soldiers on board, or other persons officially +attached to fleets or armies, whatever their nationality, shall be +respected and tended by the captors. + +_Article 12_ + +Any war-ship belonging to a belligerent may demand the surrender of +sick, wounded, or shipwrecked men on board military hospital-ships, +hospital-ships belonging to relief societies or to private individuals, +merchant-ships, yachts, or boats, whatever the nationality of such +vessels. + +_Article 13_ + +If sick, wounded, or shipwrecked persons are taken on board a neutral +war-ship, precaution must be taken, so far as possible, that they do not +again take part in the operations of the war. + +_Article 14_ + +The sick, wounded, or shipwrecked of one of the belligerents who fall +into the power of the other belligerent are prisoners of war. The captor +must decide, according to circumstances, whether to keep them, send them +to a port of his own country, to a neutral port, or even to an enemy +port. In this last case, prisoners thus repatriated may not serve again +while the war lasts. + +_Article 15_ + +The sick, wounded, or shipwrecked, who are landed at a neutral port with +the consent of the local authorities, must, in default of arrangement to +the contrary between the neutral State and the belligerent States, be +guarded by the neutral States so as to prevent them from again taking +part in the operations of the war. + +The expenses of tending them in hospital and interning them shall be +borne by the State to which the shipwrecked, sick, or wounded persons +belong. + +_Article 16_ + +After every engagement, the two belligerents shall, so far as military +interests permit, take steps to look for the sick, wounded, and +shipwrecked, and to protect them, as well as the dead, against pillage +and improper treatment. + +They shall see that the burial, whether by land or sea, or cremation of +the dead shall be preceded by a careful examination of the corpse. + +_Article 17_ + +Each belligerent shall send, as early as possible, the military marks or +documents of identity found on the dead and a list of the names of the +sick and wounded picked up by him to the authorities of their country, +navy, or army. + +The belligerents shall keep each other informed as to internments and +transfers as well as to the admissions into hospital and deaths which +have occurred among the sick and wounded in their hands. They shall +collect all the objects of personal use, valuables, letters, etc., which +may be found in the captured ships, or which may have been left by the +sick or wounded who died in hospital, in order to have them forwarded to +the persons concerned by the authorities of their own country. + +_Article 18_ + +The provisions of the present Convention do not apply except between +Contracting Powers, and then only if all the belligerents are parties to +the Convention. + +_Article 19_ + +The Commander-in-Chief of the belligerent fleets shall give detailed +directions for carrying out the preceding Articles and for meeting cases +not therein provided for, in accordance with the instructions of their +respective Governments and in conformity with the general principles of +the present Convention. + +_Article 20_ + +The Signatory Powers shall take the necessary steps in order to bring +the provisions of the present Convention to the knowledge of their naval +forces, and especially of the members entitled thereunder to immunity, +and to make them known to the public. + +_Article 21_ + +The Signatory Powers likewise undertake to enact or to propose to their +Legislatures, if their criminal laws are inadequate, the measures +necessary for checking in time of war individual acts of pillage and +ill-treatment in respect to the sick and wounded in the fleet, as well +as for punishing as an unjustifiable adoption of naval or military +marks, the unauthorised use of the distinctive marks mentioned in +Article 5, by vessels not protected by the present Convention. + +They shall communicate to each other, through the Netherland Government, +the enactments for preventing such acts at the latest within five years +of the ratification of the present Convention. + +_Article 22_ + +In the case of operations of war between the land and sea forces of +belligerents, the provisions of the present Convention are only +applicable to the forces on board ship. + +_Article 23_ + +The present Convention shall be ratified as soon as possible. + +The ratifications shall be deposited at The Hague. + +The first deposit of ratifications shall be recorded in a Protocol +signed by the Representatives of the Powers which take part therein and +by the Netherland Minister for Foreign Affairs. + +The subsequent deposits of ratifications shall be made by means of a +written notification, addressed to the Netherland Government and +accompanied by the instrument of ratification. + +A duly certified copy of the Protocol relating to the first deposit of +ratifications, of the notifications mentioned in the preceding +paragraph, and of the instruments of ratification, shall be immediately +sent by the Netherland Government through the diplomatic channel to the +Powers invited to the Second Peace Conference, as well as to the other +Powers which have acceded to the Convention. The said Government shall, +in the cases contemplated in the preceding paragraph, inform them at the +same time of the date on which it received the notification. + +_Article 24_ + +Non-Signatory Powers which have accepted the Geneva Convention of July +6, 1906, may accede to the present Convention. + +A Power which desires to accede notifies its intention in writing to the +Netherland Government, forwarding to it the act of accession, which +shall be deposited in the archives of the said Government. + +The said Government shall immediately forward to all the other Powers a +duly certified copy of the notification, as well as of the act of +accession, mentioning the date on which it received the notification. + +_Article 25_ + +The present Convention, duly ratified, shall replace, as between +Contracting Powers, the Convention of July 29, 1899, for the adaptation +to naval warfare of the principles of the Geneva Convention. + +The Convention of 1899 remains in force as between the Powers which +signed it but which do not also ratify the present Convention. + +_Article 26_ + +The present Convention shall take effect, in the case of the Powers +which were parties to the first deposit of ratifications, sixty days +after the date of the Protocol recording such deposit, and, in the case +of the Powers which shall ratify subsequently or which shall accede, +sixty days after the notification of their ratification or of their +accession has been received by the Netherland Government. + +_Article 27_ + +In the event of one of the Contracting Powers wishing to denounce the +present Convention, the denunciation shall be notified in writing to the +Netherland Government, which shall immediately communicate a duly +certified copy of the notification to all the other Powers, informing +them of the date on which it was received. + +The denunciation shall only operate in respect of the denouncing Power, +and only on the expiry of one year after the notification has reached +the Netherland Government. + +_Article 28_ + +A register kept by the Netherland Ministry for Foreign Affairs shall +record the date of the deposit of ratifications effected in virtue of +Article 23, paragraphs 3 and 4, as well as the date on which the +notifications of accession (Article 24, paragraph 2) or of denunciation +(Article 27, paragraph 1) have been received. + +Each Contracting Power is entitled to have access to this register and +to be supplied with duly certified extracts from it. + +In faith whereof the Plenipotentiaries have appended their signatures to +the present Convention. + +Done at The Hague, October 18, 1907, in a single original, which shall +remain deposited in the archives of the Netherland Government, and of +which duly certified copies shall be sent, through the diplomatic +channel, to the Powers invited to the Second Peace Conference. + + + + + INDEX + + + Aboukir Bay, 40 + + Administration, Army Medical, 61 + + Alderson, Mr., 40 + + Ambulance trains, 47-48 + + Antityphoid inoculation, 18 + + Arab servants, 41 + + Arbitration Commission, 39 + + Area medical officers, 3 + + Arrival of wounded in crisis, 43 + + Atelier, the (_see also_ Hospitals, Auxiliary), 36-51 + + Aural diseases, 92-99 + + Australia, a clean, 118 + + Australia, a white, 118 + + Australian Army Medical Reserve, 4 + + Australian Government, the, 29, 30, 40, 52, 91 + + Australian Intermediate Base, 29 + + + Baird, Sir Alexander, 39, 142 + + Barrett, Lt.-Col. J. W., 23, 29, 39, 73, 92-98, 120, 138 _et seq._ + + Base hospitals, 1, 2 + + Base medical store, 79 + + Beds, palm wood, 29, 30 + + Bilharzia, 99 + + Birdwood, General Sir William, 89, 115-121, 154, 199 + + Boards, Medical, on invalids, 70 + + Bridges, the late General Sir Walter, 6, 89, 115 + + Bronchitis, 6, 86 + + Brookes, Mr. Norman, 144 + + Brown, Major, 52 + + Buildings, acquisition, 26 + + Burials of Australians in Cairo, 103 + + + Camp, Convalescent, Zeitoun, 57 + + Casino, the, Heliopolis (_see_ Hospitals, Auxiliary), 28 + + Casualties, table showing, 90 + + Casualty Clearing Station, 8 + + Cecil, Lord Edward, 142 + + Chaplains, value of, 194 + + Cholera, 38, 106-109 + + Climate, the Egyptian, 58, 59, 104, 105 + The Khamsin, 26, 58, 59, 104 + Wet Bulb records, 58-59 + + Clubs, Soldiers' (_see_ Soldiers' Clubs and Red Cross), 125, 133 + + Commander-in-Chief (G.O.C.-in-C.) (_see also_ General + Sir John Maxwell), 39, 106, 196 + + Commissioners, Australian Red Cross, 144 + + Compulsory military training, 3, 4 + + Consultants, 192 + + Cook, Mr. Joseph, 5 + + Crisis, the, 35, 60 + + Cuscaden, Colonel, 6 + + + Dardanelles, 27 + + Deaths, + No. 1 Australian General Hospital, 110 + No. 2 Australian General Hospital, 111 + + Dentists, 192, 193 + + D.G.M.S. Australia, 6 + + Discipline, 61-65 + + Diseases, Infectious, 109 + Report on extent of, 87-90 + + Disinfection, recruits' clothing, 98 + + D.M.S. Egypt (_see also_ Surgeon-General Ford), 23, 25, 26, 27, 30, + 42, 50, 87, 88, 125, 141, 167, 205 + + Dunn, Captain, 149 + + Dysentery, 99, 109 + + + Elgood, Mrs., work of, 155, 180 + + Enlistment of the unfit, 90, 91 + + + Fergusson, Her Excellency Lady Helen Munro, 137, 138 + + Fetherston, Colonel, 6 + + Fisher, Mr. Andrew, 5 + + Flies, cause of disease, 209 + + Fly campaign (1916), 207 + The house, 99-103 + Traps, 208 + + Ford, Surgeon-General (_see also_ D.M.S. Egypt), 21, 28, 73, 101 + + Funds, Multiplicity of, 219-224 + + + Garages, 42 + + Geneva Convention, 13, 14, 18, and Appendix I + + Gordon House, 39 + + "Grouser," the, 196 + + + Hospital organisation, 229-230 + + Hospitals: + Auxiliary Australian, closure, 206 + Base, 8 + No. 1 Stationary, 8, 27 + No. 2 Stationary, 8, 27 + No. 1 Australian General: + Causes of death in, 110 + Chronology of, 40-41 + Closure of, 206 + Description of building, 21-23 + Difficulties in recruiting, 8, 9 + Expansion, 25, 35 + Finance arrangements between Governments, 60, 61 + Growth of, 53 + Ice chests, 105 + Lack of reinforcements, 38 + Number of cases admitted, 53-54 + Policy of expansion, 41 + Result of expansion, 38 + Staff available, 44, 45-46, 47 + No. 2 Australian General, 35, 111 + Closure of, 206 + No. 3 Australian, closure, 207 + Venereal Diseases, Abbassia, 27, 28 + Convalescent, 35, 59 + Al Hayat, Helouan, 35, 57, 59, 204 + Catering at, 51 + Grand Hotel, Helouan, 37 + Montazah (_see also_ Red Cross), 37, 59 + Ras el Tin, 36, 59 + Zeitoun Camp, 59 + Auxiliary, 36, 41, 49-52; + made independent, 53 + Infectious Diseases, Abbassia, 37-52 + Infectious Diseases, Choubra, 37 + Military, proposed reforms, 189 _et seq._ + Australian, evils of dual control, 204 + + + Infectious Diseases Camp, 25, 26 + + Invalids, transport of, 69-76 + + + Jackson, Stonewall, 64-65 + + Japan, Emperor of, 121 + + Jessop, Mr., work of (_see_ Y.M.C.A. and Red Cross), 133 + + + Kendrew, Colonel, work of, 194 + + Kitchener, Lord, 116, 118 + + Knox, Mr. Adrian, 144 + + _Kyarra_, voyage of, 13-18 + As hospital carrier, 78 + Decomposing food, 16 + Explanation of defects, 18 + Overcrowding of, 15 + Ptomaine poisoning, 15 + Sanitation of, 15 + Wet decks, 16 + + + Lemnos, 105 + + Lessons, Russo-Japanese War, 7 + + Lines of Communication Medical Units, 6 + + Local purchase orders, 97 + + Luna Park (_see also_ Hospitals, Auxiliary), 27, 28, 49-51, 54 + Pavilion, 30 + Rink, 38 + Success of hospital, 207 + + + Maadi, 21, 22 + + Mackenzie, Captain, 22, 111 + + MacMahon, His Excellency Sir Henry, 126, 142, 143, 144, 167, 199 + Her Excellency Lady, 40, 168, 169 + + Malingerers, 97 + + Manifold, Colonel, 76, 106 + + Martin, Lt.-Col., 14, 143 + + Masseurs, need of, 194 + + Maxwell, General Sir John, 116, 123, 125, 167 + + Measles, 6, 97-99 + + Medical organisation in Egypt, 106 + Reserve, a Junior, 54 + Students, enlistment of, 10 + + Mena House and Hospital, 6, 21, 24, 35, 43 + + Methods of organising hospitals, 39 + + Morality in Cairo, 123, 124 + + Mortality low in Cairo, 103, 104 + + Mortality in transit, 6 + In camp in Australia, 7 + + Motor Ambulances, 41-43 + Transport of sick, 60 + + "Muddling through," 205 + + Mudros, 27 + + + New Zealand sick and wounded, + British Military Hospital, Citadel, Cairo, 22 + Egyptian Army Hospital, Abbassia, 22 + + Nurses' Rest Homes, 40 + + + Oculists, 24 + + Ophthalmic work, 92-97 + + + Palace of Prince Ibrahim Khalim, 39 + + Pneumonia, 6, 86 + + Port Said, 21 + + Prevention of disease: + Prophylactic staff, 225 + Lack of Australian Military School, 225 + + Prophylactic officer, 193 + + Prophylaxis, 83 + + Ptomaine poisoning, 6, 15, 103 + + + Recruits' condition on arrival, 226 + + Red Cross, 37, 39, 42, 48, 50-53, 59, 77, 79, 125, 133 + Brown's Census (Major), 172-174 + Bureau of Inquiry, 155 + Chapter on, 137 et seq. + Colonel Onslow's letter, 149-150 + Creation of Australian Branch, 137 + Difficulties at Mudros, 154 + Distribution of goods, 152-153, 159-168 + Elgood's (Mrs.) help, 155 + Goods for 1st A.G.H., 10 + Injudicious help, 181 + Japanese methods, 180 + Jessop (Mr.), help of, 169 + Money distribution, 147-148 + Montazah, 156, 157 + Motor transport, 157, 158 + Nurses' Rest Homes, 169 + Policy, 169, 170 + Purchase of goods, 156 + Ras el Tin, 35 + Soldiers' Clubs, 166-167 + Store, 148 + Trains for invalids, 166 + Verses (Malines), 174-176 + Wanted, a policy, 177-182 + + Red Cross Society: + Articles supplied by, 212-216 + Functions of (Sir H. MacMahon), 210-212 + Lists of articles, 212-216 + Many changes in organisation, 217 + Reformed methods requisite, 218 + + Red-Tape, 197 + + Request by Imperial Government for medical units, 8 + + Robson, Mayo-, Colonel, 201 + + Ryan, Colonel Charles, 4, 6, 51 + + + Savoy Hotel, 41 + + Sellheim, Brigadier-General, 29, 30, 31, 116, 142, 196 + + Services of Anglo-Egyptians, 230-34 + + Shepheard's Hotel, 41 + + Ships, Hospital, 78, 79 + + Smith, Ramsay, Lt.-Col., Introduction, 23, 29, 141 + + Soldier's Clubs (_see also_ Clubs and Red Cross), 35, 51, 65, 125, 133 + Conduct of, 115-118 + Warning to, 119 + + Specialists, lack of, 192 + Oculist and aurist, 10 + Radiographer, 10 + + Spectacle maker requisite, 97 + + Spens, General, 120 + + Sporting Club Hospital, 36, 51 + + Springthorpe, Lt.-Col., 143 + + Staff, erratic changes of, 197-199 + + Stomach ache, Egyptian, 105 + + Suez Waiting Camp, 77 + + Sultan, H.H. the, 199 + + + Table showing number invalided to Australia, 80 + + Throat diseases, 92-97 + + Thomson, Sir Courtauld, 143, 201, 205 + + Train to Heliopolis, 30 + + Transport to Australia, 77-79 + Wounded to Suez, 79-81 + Wounded by sea, 77 + + Treves, Sir Frederick, 200, 201 + + + Venereal diseases: + Camp, 25-26 + Conference on, 129 _et seq._ + Essence of problem, 127 + Length of stay of cases, 90 + Policy, 128, 129 + Prevalence of in 1916, 209 + Prevalence of in arrivals, 228 + Prophylaxis, 124, 125 + Removal from Egypt, 121, 122 + + + Wassermann tests, 128 + + Watson, Captain, 128 + + Watson, Major, 111 + + Williams, Surgeon-General, 3, 4, 6, 25, 29, 30, 31, 41, 42, 77, + 86, 90, 101, 129, 139 _et seq._ + + Women, employment of, in hospitals, 191 + + + Y.M.C.A., 37, 50, 65, 125, 133 + + Y.M.C.A. organisation and work, 209-210, 218-224 + + Yuille, Captain Max, 141, 149 + + + Postscript, 206 + + Appendix I., 237 + + " II., 246 + + + + + H. K. LEWIS & CO. LTD. + 136 GOWER STREET, LONDON, W.C.1 + AND PRINTED BY HAZELL, WATSON & VINEY, LD. + LONDON AND AYLESBURY. + + + + + Transcriber's Notes + +Obvious punctuation errors repaired. + +Some numbers in the tables are mistaken but have not been changed. + +P. 35: "late" changed to "date" (at a later date became capable). + +P. 44: "elequent" changed to "eloquent" (bore eloquent testimony). + +P. 182: "P. S. DEANE" changed to "P. E. DEANE". + +P. 258: Index entry for "Hospitals: Convalescent, Al Hayat, Helouan" +changed from "304" to "204". + +P. 259: Index entry for "Transport to Australia, Wounded to Suez" +changed from "79-61" to "79-81". + + + + + +End of the Project Gutenberg EBook of The Australian Army Medical Corps in +Egypt, by James W. Barrett and Percival E. Deane + +*** END OF THE PROJECT GUTENBERG EBOOK 41911 *** |