The Australian Army Medical Corps in Egypt

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 gonorrhœa 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 gonorrhœa 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 gonorrhœa, and this is particularly noticeable among Queensland troops, where the general ratio of one syphilis to six gonorrhœa is now more like one to one, and occasionally the cases of gonorrhœa 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