The Australian Army Medical Corps in Egypt

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 amœbic 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 diarrhœa and of both amœbic and bacillary dysentery made their appearance. There is good ground for believing that many so-called diarrhœal 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 AustralianGeneral Hospital

From February to July inclusive

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. 2Australian General Hospital, Ghezireh

From May 3, 1915, to 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.