Patients admitted during June 2,862

RED CROSS SUPPLIES

Pyjamas 790 Face washers 1,000 Sheets 900 Towels 1,500 Sponges 1,500 Handkerchiefs 1,500 Cotton shirts 950 Socks 1,000 Slippers 500 Pillowslips 1,000

Special hospital organised hurriedly by the department on June 17.

Ras el Tin Convalescent Home, Alexandria.

RED CROSS SUPPLIES

Socks 1,000 Shirts 1,500 Pyjamas 750 Sheets 750 Blankets 750 Pillowslips 750 Face washers 1,500

_July_

Wounded still pour in. Sporting Club increased by addition of tennis court wards, Atelier and Luna Park accommodation increased.

Patients admitted in July 2,194

RED CROSS SUPPLIES

Sheets 2,000 Slippers 1,000 Pillowslips 3,400 Blankets 1,900 Shirts 2,000 Handkerchiefs 2,000 Towels 3,000 Socks 3,400 Face washers 3,000

_August_

Choubra Infectious Hospital hurriedly established and equipped by the department; 400-bed tent hospital added to Sporting Club.

RED CROSS SUPPLIES

Blankets 2,000 Cotton sheets 1,800 Towels 1,700 Handkerchiefs 2,400 Face washers 2,300 Socks 2,800 Pillowslips 214

CHAPTER X

SUGGESTED REFORMS--DEFECTS WHICH BECAME OBVIOUS IN WAR-TIME--RECOMMENDATIONS TO PROMOTE EFFICIENCY--DANGERS TO BE AVOIDED--CONCLUSION.

CHAPTER X

The experience gained in connection with the establishment and extension of the First Australian General Hospital suggests modifications which should immensely increase efficiency. A base hospital modelled on the R.A.M.C. pattern may work exceedingly well in times of peace, or when staffed by R.A.M.C. or I.M.S. officers who have devoted their whole lives to the work. But base hospitals constructed during a great war, and staffed almost entirely with civilian elements the majority of whom are untrained in administration of any kind, do not work in all cases with the necessary degree of smoothness. It certainly does appear that changes in the base hospital establishment might be introduced with advantage.

In the first place there arises the question whether it is necessary for the Commanding Officer to be a medical pract.i.tioner, or whether, as in the case of the convalescent hospitals, he might be a combatant officer, or at all events a non-medical officer. The general consensus of opinion is that he should be a medical officer, though there is a great deal to be said on the other side. Almost the whole of his work is administrative, though he necessarily must have a good knowledge of clinical methods. But unless such an officer be selected not simply with regard to seniority, but with regard to experience in administrative methods, and unless he be tactful and watchful, troubles are very likely to ensue. His task is beset with difficulties if he possesses character and insists on efficiency. Whatever doubt there may be, however, about the Commanding Officer, there need be none about many of the other positions. A noteworthy feature of the First Australian General Hospital was the continual complaint from the medical officers that they had not come away to do administrative work. This distaste for administrative work was a constant source of trouble.

The Registrar, as the princ.i.p.al executive officer of the hospital, whose business it is to carry out the decisions of the Commanding Officer, is at present invariably a medical officer. The greater part of his work does not need medical knowledge, and the difficulty might be obviated by the adoption of one of two methods. Either the Registrar might be an educated business man or he might have such a one as his immediate understudy. In the latter event a very small portion of his day would be taken up with the duties of the Registrar's office.

Similarly the orderly officer, whose business it is to deal with details concerning the rank and file, is usually a medical officer, and in some hospitals it is the practice to change this officer from day to day. At No. 1 General Hospital, however, his functions were so important that one medical officer was permanently told off to do this work. There is no doubt that the orderly officer need not be a medical officer, and might well be an invalided combatant officer, transferred to the army medical service.

Owing to modern developments another officer has made his appearance who is not provided for in any establishment--that is, the transport officer. Motor transport has become so large a portion of the work of the base hospital that a special officer is requisite for the purpose.

There is no reason whatever why such an officer should be a medical man.

If these changes were made it would result in releasing at least three officers for clinical purposes.

The amount of clerical work that was necessitated by the returns furnished to the War Office, the Australian Government, Headquarters Egypt, and other departments was so great that a large staff of very competent clerks was required. The future establishment should certainly include not only a number of trained stenographers, but some one versed in statistical work. The lessons to be learned are so numerous and so important that something of the kind should be done. Furthermore, in the Quartermaster's department there was a demand not only for stenographers, but for men who had been accustomed to the methodical ways of a large warehouse.

Were all these changes made there is no doubt that the efficiency of the administration would be increased and the burden of the work lightened.

As regards clinical work other desirable changes might be made. Senior men who have been in full practice, and who come to a base hospital as physicians or surgeons with the rank of lieutenant-colonel, are apt to be entrusted with the detailed administration of medical or surgical wards. They are often unfitted by training for such administration and are frequently disinclined to undertake the work. It would be far better to leave the actual detailed administration of the wards in the hands of a comparatively junior man with the rank of major, and to retain these senior officers as consultants only. Consultants of course possess great powers, since their authority as regards the clinical work itself is absolute. They can do as much or as little as they like, but they are in complete control and are absolutely responsible for the treatment of the cases. Our own feeling is that in such a position they would be far more comfortable and would be more efficient.

On the subject of specialists there is much to be said. It is almost incredible that a base hospital should have been formed without being provided with an ophthalmic and aural specialist. The change has been made since war began, but it seems inconceivable that any one should have contemplated the efficient handling of wounds and diseases without such aid. At the First General Hospital the ophthalmic and aural department was the largest and most heavily worked department in the hospital, partly owing to the fact that one of us had been appointed Consulting Oculist to the Forces in Egypt, and that much of the work consequently centred at Heliopolis.

Similarly the failure of the Australian Government to provide dentists in the first instance is difficult to understand. The day has gone by when it is possible to exclude from the force a man who possesses dentures or defective teeth, and it is practically impossible to complete the work for the recruits before they leave. So it became necessary at No. 1 General Hospital to borrow two dentists from the New Zealand Government, to fit them out with Red Cross money and goods, and in this way to meet informally the difficulty. Subsequently the Australian Government appointed a corps of dentists, and the problem was to some extent solved, though even now the demand far exceeds the supply. There is no doubt that dentists are wanted not only at the base hospitals, but also near the firing line, as the dispatch of a man from the firing line to the base hospital to obtain dental treatment represents a waste of time and money.

It is further desirable to attach one or more anaesthetists to every hospital.

It must, however, be said that the constant changes of staff which took place at No. 1 Hospital owing to the various exigencies of the military situation rendered it extremely difficult to keep a physician or surgeon in any fixed position for any length of time. Consequently a certain amount of pliability and adaptability was absolutely necessary. At the same time, if the organisation were sketched in the manner indicated, the problem would have been more simple, and good results easier to obtain.

There is no doubt that one medical officer (who could be attached to the Pathological Laboratory in addition to the Clinical Pathologist) should devote himself entirely to sanitary work. This duty is not taken too seriously, and should be emphasised. It would really be better to rename this officer the "Prophylactic Officer," unless a better term can be found, and it should be his aim and duty, not simply to enforce cleanliness, but to actively exert himself to ward off disease.

Stress may be laid on the usefulness of a sensible chaplain, whose value depends on his own interpretation of his duties. The chaplain (Colonel Kendrew) at No. 1 General Hospital not only attended to the religious needs of men, but earned their affection and respect by managing the extensive post office and library, the canteen, and by helping with Red Cross work. It is just these badly defined functions in a base hospital which a chaplain can discharge so well.

We think also that women might be used in base hospitals as stenographers, ward maids, telephone operators, and the like. Base hospitals in the future are not likely to be housed in tents, and under rough conditions. At present, trained nurses are sent to the Stationary Hospitals. It seems a pity to waste fine young men, who could be combatants, as orderlies in a base hospital.

Ma.s.seurs are certainly badly wanted in a base hospital, and it is difficult to understand the objection to their incorporation. The difficulty was removed in Egypt by employing Egyptians.

Electricians, _i.e._ orderlies who in civil life are electricians, are required in every base hospital, and at Heliopolis they were invaluable for general purposes, and as aids to the radiographer. They should, however, form part of the establishment, and should number two or three.

Is it not clear that chefs, laundrymen, skilled carpenters, and other tradesmen are also required?

The table which follows represents the establishment of the ordinary 520-bed hospital, R.A.M.C. It has been adopted by Australia, but the Australian establishment allows for 93 nurses instead of 43. If the foregoing suggestions are adopted, as we think they should be, this table would require material alteration.

A GENERAL HOSPITAL (520 BEDS) WAR ESTABLISHMENTS

----------------------+--------------------------------------------------- PERSONNEL.

DETAIL. +---------+----+-----------+--------+--------+------ Officers.W.O.St. Sergts.Buglers.Rank andTotal.

and Sergts. File.

----------------------+---------+----+-----------+--------+--------+------ Lieut.-Col. in charge 1 -- -- -- -- 1 Lieut.-Cols. 2 -- -- -- -- 2 Majors-- Sec. and Registrar 1 -- -- -- -- 1 General Duties 4 -- -- -- -- 4 Captains or Subs. 12 -- -- -- -- 12 Quartermaster 1 -- -- -- -- 1 Warrant Officers -- 2 -- -- -- 2 Sergeants-- Nursing Duties -- -- 4 -- -- 4 Steward -- -- 1 -- -- 1 Dispenser -- -- 2 -- -- 2 Cook -- -- 1 -- -- 1 Pack Storekeeper -- -- 1 -- -- 1 Linen " -- -- 1 -- -- 1 Clerks -- -- 3 -- -- 3 Buglers -- -- -- 2 -- 2 Corporals-- Steward -- -- -- -- 1 1 Cook -- -- -- -- 1 1 Clothing Storekeeper -- -- -- -- 1 1 General Duties -- -- -- -- 1 1 Supernumeraries -- -- -- -- 3 3 Privates-- Steward's Stores -- -- -- -- 2 2 Cooks -- -- -- -- 3 3 Pack Stores -- -- -- -- 1 1 Linen " -- -- -- -- 1 1 Clothing " -- -- -- -- 1 1 Clerks -- -- -- -- 2 2 Ward duties -- -- -- -- 66 66 Batman -- -- -- -- 25 25 General Duties -- -- -- -- 11 11 Supernumeraries -- -- -- -- 6 6 ----------------------+---------+----+-----------+--------+--------+------ TOTAL 21 2 13 2 126 164 ----------------------+---------+----+-----------+--------+--------+------

With reference to the duties of N.C.O.s and men, nothing gave more trouble than the fact that men recruited in Australia were made N.C.O.s before their special qualifications were known. There is no officer in the Army whose position is so thoroughly safeguarded as the N.C.O., and nothing but the adverse decision of a court martial can effect his removal. Yet an unsuitable and even dangerous man, from the point of view of the sick, may do nothing to warrant a court martial (which no one enjoys). These appointments should be made therefore with great care. Such considerations, of course, lead to but one conclusion, viz.

the necessity for sketching out these hospitals in time of peace.

Scratch enlistments are too dangerous.

The "grouser" is always with us, and sometimes gives trouble. The particular Australian "grouse" was that the Australian hospitals should have been nearer the front than Cairo, and at last No. 3 Australian General Hospital was placed at Mudros.