The Australian Army Medical Corps in Egypt

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. 1General and No. 2 Stationary Hospitalson Fore Deck

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.

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.

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.

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.

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.

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.