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diff --git a/41911.txt b/41911.txt deleted file mode 100644 index 6a743ca..0000000 --- a/41911.txt +++ /dev/null @@ -1,8721 +0,0 @@ -The Project Gutenberg EBook of The Australian Army Medical Corps in Egypt, by -James W. Barrett and Percival E. Deane - -This eBook is for the use of anyone anywhere at no cost and with -almost no restrictions whatsoever. You may copy it, give it away or -re-use it under the terms of the Project Gutenberg License included -with this eBook or online at www.gutenberg.org - - -Title: The Australian Army Medical Corps in Egypt - An Illustrated and Detailed Account of the Early - Organisation and Work of the Australian Medical Units in - Egypt in 1914-1915 - -Author: James W. Barrett - Percival E. Deane - -Release Date: January 24, 2013 [EBook #41911] - -Language: English - -Character set encoding: ASCII - -*** START OF THIS PROJECT GUTENBERG EBOOK AUSTRALIAN ARMY MEDICAL CORPS IN EGYPT *** - - - - -Produced by Moti Ben-Ari and the Online Distributed -Proofreading Team at http://www.pgdp.net. (This file was -produced from images generously made available by The -Internet Archive.) - - - - - - - - - - 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 anaesthetic. 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 deg.F. Wet Bulb is high, and that at -80 deg.F. Wet Bulb work becomes difficult. At 90 deg.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 1/4, 1/2, 3/4, 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 L150 to L200, 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 _a 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 deg. 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 sequelae 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 cafes 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 deg. -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 deg. to 95 deg. Dry Bulb, and -the nights perhaps 65 deg. to 70 deg. 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 Septicaemia - | | | 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 Septicaemia - | | | 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 -L10,000 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 L10,000 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 L10,000, but when, on July 9, L18,000 -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 L10,000 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 {L50 L25 L25} 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' Cafe, 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 - ---------- - LE.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 L500 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 L3,500 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, -L7 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 L250 available and required L1,000. The British -Red Cross Society was appealed to and hesitated. A cable was dispatched -to London, and an expenditure of L250 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 L500 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 anaesthetists 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 faeces 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 Societe Maternelle Fund_ - -"To collect funds for the Societe 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 _proces 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 _materiel_ 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. 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