Fortunately, as a result of the efforts made, the tendency was to diminution, but the amount of venereal disease was still sufficiently great to give concern and anxiety.

There is no doubt that the action of General Birdwood prevented outbreaks and limited the amount of disease. It is also equally true that in spite of his efforts the amount of disease was too large to be contemplated with equanimity.

The Venereal Diseases Hospital, Abba.s.sia, was nearly always full, but from time to time drafts of men were sent back to Australia. One draft of 450 soldiers was sent to Malta early in the campaign. The principle involved in the policy of returning them to Australia was as follows. In Egypt they were useless as soldiers, whether suffering from gonorrhoea or syphilis. They required a large number of medical men and attendants to take care of them. They knew they had disgraced themselves and were a source of trouble to every one concerned. On shipboard they could not get into trouble. They were more likely to be cured, and could then be returned to Egypt, and if not cured could be treated in Australia at leisure. Against this policy the argument was used that diseases were being introduced into Australia, but as a matter of fact a minority of the men suffering from venereal disease brought it from Australia to Egypt. They arrived at Suez suffering from gonorrhoea contracted in some cases at Fremantle. Furthermore the business of those conducting the campaign was to wage a successful war, and to keep the base as free from enc.u.mbrance as possible. The total number returned to Australia in this way was as follows:

From February to September 14, 1,344, and in addition 450 were sent to Malta.

At first they were sent in ships with other cases and sometimes segregated on board, but difficulties arose at the Australian ports. The people who welcomed the returned soldiers were sometimes enthusiastic in greeting venereal cases by mistake, and sometimes non-venereal cases were regarded with suspicion because they came from a ship known to convey venereal patients. It was finally decided by the Australian Government that venereal cases should be conveyed in ships by themselves, the first consignment of 369 being sent in the _Port Lincoln_.

A certain number of the gonorrhoeal cases recovered and became fit for service, but too often they relapsed.

The authorities were fully alive to the damage which was being done, and persistent and earnest attempts were made to deal with it from many different points of view. General Maxwell issued an order prohibiting the sale of drink after an early hour (10 p.m.) in the evening, and also prohibiting soldiers from being found in Cairo after an early hour.

There is no doubt that both of these directions proved to be of considerable value.

MORAL CONDITIONS IN CAIRO

Something must be said, however, about the moral conditions in Cairo, about which exaggerated and perverse notions seem to be entertained.

Cairo, like all large cities in the world, possesses its quota of prost.i.tutes, who differ only from prost.i.tutes elsewhere in that the quarters are dirtier and that the women are practically of all nationalities, except English. The quarter in which they live is evil-smelling, and is provided with narrow streets and objectionable places of entertainment. It contains a considerable infusion of Eastern musicians and the like, and is plentifully supplied with pimps of the worst cla.s.s. These men were promptly dealt with by the police, the authorities giving the most sympathetic a.s.sistance to the military.

As in other countries, there were graduations in the cla.s.s of women employed, and the personal impression gained by the authorities was that the danger of infection was greatest from those at the top and the bottom of the social scale. Prost.i.tutes who were registered were examined by a New Zealand gynecologist, who did the work very thoroughly, and conscientiously, and with kindness. Women who were free from disease were furnished with a ticket indicating that they were healthy. At the beginning of the war there were 800 of these women in Cairo, but as the war progressed the number grew to 1,600. The arrangement then differed in no way from the arrangements in Melbourne or Sydney except that the surveillance of the police was direct, and medical examination was insisted upon. It further had this advantage over those of Melbourne and Sydney, that the women were confined to one particular part of the city, and no one need come in contact with them unless they wanted to. Consequently for those who went to this quarter there is no excuse, since they acted deliberately.

PROPHYLAXIS

At the same time, when all these measures were weighed in the balance--plain speaking to the men on arrival, police surveillance, medical examination, etc.--it was felt that more might be done. A number of medical officers accordingly gave instruction to their men in the means of effecting prophylaxis and of preventing infection in the event of a.s.sociation with these women. The medical officers acted entirely on their own responsibility. They advised the men to avoid the risk, but as they knew a certain number would not take their advice in any circ.u.mstances--in fact the men said as much--they showed them how to avoid infection if they would take the necessary trouble.

RESULT OF PROPHYLAXIS

In the case of our own unit, the First Australian General Hospital, trouble was taken to explain in detail the consequences of venereal diseases to the men, and to those with whom they would be a.s.sociated in later life. They were asked to refrain from taking the risk, but for those who would not take the advice--and there was bound to be a percentage--the necessary directions and material were provided for preventing infection. The result was challenged by a medical officer, and an immediate examination of all the men made, when it was found that in the whole of the unit only one man was infected. In other words, the precautions taken had practically stamped the disease out of the unit, and shortly after arrival in Cairo.

Once the disease was acquired the treatment was troublesome to a degree.

The men knew they were disgraced; they would probably be sent back to Australia; and in some cases, those of the finer men, the consequences were serious. Mostly, however, they developed an att.i.tude of sullenness and indifference, a tendency to lack of discipline, and they rendered the management of camps difficult. These troubles to a large extent disappeared when a suitable hospital was established.

SOLDIERS' CLUBS

But another and constructive side of the matter appealed forcibly to those concerned. Why not supply for the benefit of the men places of entertainment with music, refreshments, and the like, similar to and better than those which the prost.i.tutes supplied, but minus the prost.i.tute. In other words, why not give a healthy and reasonable alternative? After consultation with His Excellency Sir Henry MacMahon, with the G.O.C.-in-Chief, General Sir John Maxwell, and with the D.M.S.

Egypt, General Ford, the Australian Red Cross Society determined to combine with the Y.M.C.A. and establish clubs for the soldiers in central positions where these requirements would be met. They accordingly established a club at the quay in Alexandria, and a magnificent open-air club in the Esbekieh Gardens, Cairo. They were both immediately successful, and have played a most important part in the further limitation of the amount of venereal disease. It is difficult to give statistical evidence, but there is no doubt that by these various means a sensible difference has been produced in the incidence of disease amongst the troops.

THE DUTY OF THE MEDICAL OFFICER

We have never wavered from the conviction that any one suffering from venereal disease should be treated by a medical pract.i.tioner exactly like any other sick person. In military service, however, an added element makes its appearance in that the soldier by his act has rendered himself unfit, and consequently must suffer some pains and penalties. It is no answer to say that other men have exposed themselves and have not become infected. The fact remains that he has by a deliberate and avoidable act deprived his country of the value of his services. And whilst the doctrine of punishment should not be pushed too far, he certainly should not receive the same general treatment as other soldiers, and the policy of his prompt return to Australia and deprivation of pay was in the circ.u.mstances the best one.

In the Venereal Diseases Hospital, Abba.s.sia, the men were well treated.

They were well fed, and a certain amount of Red Cross help was given to them.

Many proposals were made which were not carried into effect: for example, placing of the prost.i.tute quarter "out of bounds" and the posting of sentries. It was realised that the immediate effect of this action would have been to drive women to the vicinity of the camps, and that it was impracticable. Another practicable proposal was made, which, however, was not carried into effect--the creation of dispensaries in the vicinity of the prost.i.tute quarter, so that immediate treatment could be obtained. In many camps such dispensaries were established by the medical officers.

The essence of the problem was learnt by a Brigadier-General who visited a number of young educated men in one of the camps, and asked them for their viewpoint on the subject. Their answer was that which every medical officer knows full well: that many men were influenced by the appeals which had been made to them, but that a percentage have indulged in this way throughout their adult life, and intend to continue to do so irrespective of anything medical officers, chaplains, or generals may say to them. It is this fundamental position which every reformer must face. So long as a sufficient number of men determine to adopt this policy, and so long as there is a sufficient number of women prepared to cater for them, the problem of venereal disease will continue to be acute in every country.

The opinion has been expressed elsewhere that the world will not be rendered more or less moral by the abolition of venereal disease, and instruction in the mode of preventing infection should be an essential part of education. Because people are immoral there is no reason why they should acquire gonorrhoea or syphilis. If the _lex talionis_ is to be enforced, the logical way to deal with the matter is to refuse treatment to all the infected, and to let them die or become disabled.

But the most thorough-going Puritan shrinks from adopting so terrible a policy. One method or the other, however, must be adopted--there can be no half-way house. And if the decision be in favour of eradicating the disease, it is essential to firmly face and grapple with the problem.

Wa.s.sERMANN TESTS

The examination of the cases showed that gonorrhoea was far more common than syphilis, and a series of Wa.s.sermann determinations showed that the cases of soft sores did not give a syphilitic reaction in the early stages. Captain Watson of the First General Hospital made a number of determinations in order to try to settle this important point.

THE POLICY TO BE ADOPTED

In spite of all that was done, 1,344 men were returned to Australia disabled, and 450 were sent to Malta. If a calculation be made of the cost of sending these men to Egypt and back, and of their pay before they were infected, some idea may be formed of the enormous sum of money the Australian Commonwealth wasted on men who were a drag and hindrance to the army machine.

The Government should, on the raising and equipping of a volunteer army, treat it as older countries treat a standing army by issuing instructions to the men.

When the Hospitals left Australia neither officers nor men received instructions, and not until the arrival of Surgeon-General Williams in Egypt was any serious collective action taken. He at once called a conference of medical officers and did what he could to limit the extent of disease.

The governmental action--or lack of action--is unsound, since the man who contracts disease is severely punished, but adequate attempts are not made to prevent him acquiring it. The notable departure made in the case of Cairo was the effort to make the men understand clearly what these diseases meant to them as soldiers and as citizens; to remove temptation from them as far as possible, and with the aid of the Australian Red Cross to give them a reasonable, healthy, and decent alternative. Nothing the Australian Red Cross has done (or is likely to do) is more important than the establishment of the Soldiers' Clubs.

Nothing has been more successful or is likely so to redound to the credit of that great inst.i.tution. And yet, under the new Const.i.tution of the Australian Red Cross, not a shilling can be devoted in the future to such purposes.

VENEREAL DISEASES CONFERENCE

The following are brief notes of a Conference of senior medical officers convened by Surgeon-General Williams.

Reference was made to the gravity of the problem with which the force was faced. It was estimated that about 1,000 men of the First and Second Australian Divisions are suffering from venereal disease on any one day, and of these a large number are incapacitated from work. The proportions seemed to be much greater than those of other forces, such as the Territorials, in Egypt. The displacement of so large a proportion of men and the ultimate consequence of numerous infections, rendered it necessary to take a comprehensive view of the position, and to endeavour to take some action to minimise the damage done. It was proposed to ask each officer present to furnish the secretary with a general statement of the number of cases treated under their command, specifying them under three headings--syphilis, soft chancre, and gonorrhoea. The information so obtained would form the basis of a report to headquarters. The problem was considered under five headings:

1. Military a.s.sistance.

2. Use of prophylaxis.

3. Treatment--general and special.

4. Establishment of convalescent depots--accommodation and position.

5. Ultimate destination of affected men.

1. _In what way can the military authorities give a.s.sistance?_--There are three ways in which they can approach the problem:

(_a_) They may decide that all areas known to contain brothels are out of bounds.

(_b_) They can provide adequate military control by military police organised under a competent officer, with one or more junior medical officers to a.s.sist him.

(_c_) That punishment can be inflicted on those men who break bounds and expose themselves to the risk of venereal infection.

It might be desirable to reduce the pay of men found in those areas whether suffering from venereal disease or not.