The Australian Army Medical Corps in Egypt

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 CapsCardigansCholera Belts*Cushions, Air* " OrdinaryDressing GownsFacewashersFly VeilsGloves*HandkerchiefsMittens*Mosquito NetsMufflers*Pillows*Pillow SlipsPneumonia Jackets*Pyjamas, Cotton* " Flannel*Quilts*Sheets*Shirts, Cotton* " Flannel* " Hospital*Shoes, Deck*Slippers, Hospital*Socks* " Bed*Surgeons' Aprons* " Caps* " Gowns* " Swabs*Towels* " GlassUnderpants, Cotton" FlannelUndershirts, Cotton" FlannelFoodstuffsAllenbury's Diet" FoodArrowrootBeef ExtractBenger's FoodBiscuitsBovrilBrandyCeregenChocolateCocoaCocoa-and-MilkCoffee EssenceCoffee-and-MilkCondensed MilkCornflourCorninaFruits, Dried" TinnedGlaxoHorlick's M. MilkJamJelly CrystalsLactogenLime JuiceLinseed MealMalt ExtractOatmealPicklesPlum PuddingsPort WineRobinson's Barley" GroatsSemolinaSoda WaterSweetsTapiocaTinned Rabbits" Tomatoes" Tripe" VegetablesGeneral*Absorbent Wool*Bandages*Bed Cradles* " Rests* " ScreensBooks*Brushes, Hair* " Nail* " Tooth*Camp StoolsCigarettes*Combs*Crutches*Deck ChairsEau-de-CologneEnvelopesFly VeilsFly WhisksGramophone Needles*Hospital Basins*Hot-water BottlesHousewives*InsectibaneLooking-glassesMatches*Medicine GlassesOld Linen*Oil HeatersPencilsPeriodicalsPipes*Primus Stoves*Razors*Razor Strops*Rubber Sheeting*Safety Pins*Smoked Glasses*Soap, Monkey Brand*Soap, Shaving* " Toilet*Splints*Sponges*Tables, Folding*ThermometersTobacco*Toilet PaperTooth Paste*VaselineWriting 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. JOHNNo. of Patients – For the Use of PatientsList of Articles in Red Cross Stores which may beRequisitioned for– 191

To the Commissioner,

British Red Cross and Order of St. John

Gresham Buildings, Cairo.

Please send to – the following articles:

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 Société Maternelle Fund

"To collect funds for the Société 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 AUSTRALIALANDING 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.