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

1 Including Luna Park.

2 20 Reinforcements.

3 38 Reinforcements.

4 195 Reinforcements.

5 Auxiliaries separated and made independent.

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.

As the equipment of additional beds involved the supply of all these articles, in addition to mattresses, blankets, linen, towels, kitchens, cooking-utensils, stoves, bedside tables, ward utensils, instruments, drugs, and bandages, the strain on the Quartermaster's department during this period of expansion was very great. The supply and distribution of food to the auxiliary hospitals occasioned considerable difficulty at the beginning of the crisis, but was satisfactorily adjusted.

The Auxiliary Hospitals

As the patients became convalescent they were moved to one of the auxiliary hospitals, and from the auxiliary hospitals to one of the convalescent hospitals at Helouan or Alexandria, and thence either invalided or discharged to duty. As the patients during transference to the auxiliaries were conveyed in a motor ambulance, and when transferred to Helouan or Alexandria were motored to Cairo railway station under charge of a N.C.O., some idea of the work thrown on the motor ambulance corps and on the staff can be imagined.

So far all the auxiliary hospitals were regarded as wards of the main hospital, and administered from the main building – the only possible method of administration at this juncture. It was generally believed that the Dardanelles campaign would be of short duration, and that Luna Park and the other auxiliary hospitals would soon be closed. Consequently the expenditure of much money on these auxiliaries was deprecated. When, however, it became obvious that the operations at Gallipoli might last a very long time, and that in any event the troops pouring into Egypt from Australia and elsewhere would require hospital accommodation, an entirely new view of the matter was taken, and active steps were taken to permanently equip the auxiliary hospitals for more serious work. Of this equipment something must now be said in detail.

At Luna Park the central lake was emptied and drained, and was covered by an enormous shelter shed provided by the Australian Red Cross. The shelter with a modern kitchen provided by the authorities formed the dining-room for the patients, nearly all of whom were able to leave their beds. In addition an excellent operating-room was built in brick, barbers' shops were organised, and a canteen, store, and numerous comforts in the way of blinds, sunshades, punkahs, were provided. Ample bath and latrine accommodation was added. As time passed, the palm beds were gradually replaced by metal beds, and the total number reduced to 1,000. In the event of another emergency, beds can be again provided, to the number of 1,650, but such a step will only be taken in the presence of necessity.

Furthermore in the case of Luna Park and the other auxiliary hospitals, the D.M.S. Egypt decided that the feeding of patients should be effected by contract, and the matter was therefore left in the hands of a well-known caterer. A large amount of Red Cross money was expended on the shelter sheds and on a recreation hut managed by the Y.M.C.A., and Luna Park became an excellent open-air hospital. It is the more necessary to draw attention to this fact by reason of the adverse criticisms which have been passed by those who have only a superficial acquaintance with it. It will be sufficient to say that up to November 1, 5,500 patients had passed through it, and there had been only one death, and that from anæsthetic. This remarkable result was not altogether due to the fact that mild cases were admitted, for latterly many major operations had been performed, for appendectomy, etc., and according to Colonel Ryan, Consulting Surgeon to the Force in Egypt, all the operation cases had healed by first intention. In fact Luna Park really represents the triumph of the open-air method of treating patients in a rainless country. The patients preferred it because of the freedom the gardens gave them, but they showed one peculiarity which could never have been foreseen. The Australian soldier was not very fond of chairs. He did not want to stay in the shelter sheds, but preferred to spend much of his day lying in bed, and had to be ordered away from it to effect any change. It is not unnatural that men who have been doing excessive physical work should prefer physical rest when they can get it.

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.

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

Largest number of patients admitted on any one day (June 8, 1915):

Sick and wounded received at the First Australian General Hospital at the end of April:

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.

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 5s. a day for officers, and 3s. 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

The Egyptian Climate

Those who know Helouan and the hotel will not be surprised at the success of the Hospital, but it may surprise even those who know Egypt to learn that Helouan is considerably cooler than Cairo, notwithstanding the fact that it is situated on the edge of the desert. Owing to dryness the Wet Bulb temperature is considerably lower than at Cairo in midsummer and the nights are always cool.

It must be remembered that the figures in the attached table give means only, and that any registration over 75°F. Wet Bulb is high, and that at 80°F. Wet Bulb work becomes difficult. At 90°F. Wet Bulb the danger point is reached, and all work must cease on pain of death from heat apoplexy.

It will be seen, then, that Egypt is not especially hot, even from May till October, and that Helouan is particularly cool. These conclusions coincide with the feelings of those who live there. Alexandria is pleasant by day, because of the sea breezes, but at night most people prefer Heliopolis, which is drier and where they are more likely to enjoy a breeze.

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."

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