"May I add that I went to the Dardanelles in a transport with over a thousand of your brave soldiers, many of whom were returning to the Peninsula after having already been wounded. It is impossible to speak too highly of their gallantry, and of the splendid spirit they displayed. I need not tell you that I heard of their fighting qualities at the front, since their heroic deeds in this campaign have already become a matter of history.

"Yours sincerely, "(Signed) COURTAULD THOMSON,

"_Chief Commissioner for British Red Cross and Order of St. John, Malta, Egypt, and Near East Commission._"

[_Copy_]

EXTRACT FROM A REPORT FROM LIEUT.-COLONEL SIR COURTAULD THOMSON, CHIEF COMMISSIONER OF THE BRITISH RED CROSS AND ORDER OF ST.

JOHN, TO THE HON. ARTHUR STANLEY, DATED MAY 25, 1915.

"A striking feature in Cairo is the remarkable work which is being done by the Australian Red Cross. They have not only two exceptionally large hospitals and the large convalescent home, but they supply the motor transport for the wounded for the whole of Egypt. They have also very large Red Cross stores which they have brought with them. With these articles they have been more than generous, and I am informed that they have given away to the hospitals for our own troops something like 75 per cent. of whatever they had."

EXTRACT FROM CORPS ORDERS, MARCH 28, 1915

"_Appreciation._--The D.M.S. Egypt, who visited the Hospital yesterday afternoon, has requested the Officer Commanding to convey to the officers, nurses, N.C.O.s, and men in the Hospital his appreciation of the work done and the thorough character of the organisation."

EXTRACT FROM CORPS ORDERS, MAY 1, 1915

"_Appreciation._--The D.M.S. Egypt, Surgeon-General Ford, witnessed the detraining of the invalids who arrived here Wednesday evening. He asked Major Barrett to convey to the Officer Commanding his great appreciation of the excellence of the arrangements and the efficient and quiet manner in which the work was done.

"He congratulates officers and men on the splendid work they are doing and requests that it shall be communicated to them in Corps Orders."

Looking back, does it not seem essential that these hospitals should have been formed, at all events in outline, in time of peace? That their commanding officers and essential staff should have been marked out beforehand, so that on the declaration of war the gaps could have been filled in from the reserve without difficulty? Satisfactory appointments are much less likely to be made in the turmoil which follows the declaration of war than in the atmosphere of deliberate calm which prevails in time of peace. Had such an arrangement prevailed, the First Australian General Hospital would certainly never have been recruited from three States distant from one another hundreds of miles.

Finally, Australian hospitals in time of war should either be regarded as responsible solely to the Australian military authorities and Government, or handed over without reserve to the R.A.M.C., and placed entirely under the control of the British authorities. Where two different authorities exist, as in the case of the First General Hospital, a large amount of trouble and delay is almost certain to ensue. The adoption of the latter course is in our judgment absolutely essential if efficiency is to be secured.

As is invariably the case, weaknesses in any system are only revealed by costly experience. But while in the Australian Medical Service the experience need not have been so costly, we can at least profit by what has occurred, and frame a stronger and a better policy for the future.

[Ill.u.s.tration: AUSTRALIAN CONVALESCENT HOSPITAL, AL HAYAT, HELOUAN.

_To face page 204_]]

On the whole, the record of work done in most trying circ.u.mstances is, we think, satisfactory. It is true that the universal democratic fault was evidenced in the lack of preparation for conditions which were fairly obvious. Nevertheless the adaptability and growth of the hospitals in time of great emergency were achievements of the highest order.

Yet it would be unwise to leave the subject with the usual Anglo-Saxon expression of satisfaction that the crisis was pa.s.sed. The history reviewed has too deep a significance. It must be regarded not merely as an individual incident, but as an indication of the inefficiency evidenced by too many departments of the Empire.

The causes which found the medical services unprepared, which forced them to expand to the breaking-point, and which led to the criticism of the hospital authorities, are not departmental or sectional--they are national. If attacks on individuals are permitted, initiative will be stifled; if on the other hand we are content to follow the time-worn policy of "muddling through," the virile people who skirt the border lines of our Empire will sooner or later bid us make way for stronger men.

Our policy for the future must be one of scientific organisation and calculated preparation in every department. We must not only appoint capable administrators, but also trust them. We can again, if we like, obtain that temporary mental tranquillity which comes to a democracy--and to an ostrich--which does not or will not see the calamity which threatens it, but temporary beat.i.tude will be purchased at the price of an Empire. Never was it more certainly true that the price of liberty is eternal vigilance.

CHAPTER XI

POSTSCRIPT

CLOSURE OF AUSTRALIAN HOSPITALS--THE FLY CAMPAIGN--VENEREAL DISEASES--Y.M.C.A. AND RED CROSS--MULTIPLICITY OF FUNDS--PROPHYLAXIS--CONDITION OF RECRUITS ON ARRIVAL--HOSPITAL ORGANISATION--THE HELP GIVEN BY ANGLO-EGYPTIANS.

One of us (J. W. B.) was invalided to England in the middle of November 1915, and returned to Egypt at the end of March 1916.

He resigned his commission in the Australian Army Medical Corps on February 28, and was appointed temporary Lt.-Col. in the R.A.M.C. on February 29. On his return to Egypt he was appointed Consulting Aurist to the Forces in Egypt, and was a member of the Council of the British Red Cross Society and of the Y.M.C.A. He consequently had an opportunity of witnessing the termination of many of the arrangements for which he had been in part originally responsible, and desires to make brief reference to them.

No. 1 Australian General Hospital with its many off-shoots, including the four auxiliary hospitals and the venereal disease hospital, was located in Egypt for periods of twelve to eighteen months. No. 2 Australian General Hospital was in Egypt about fourteen months. Yet it was stated that each and every one of these hospitals when established were to be temporarily located in Egypt for a few weeks. Luna Park, _i.e._ No. 1 Auxiliary Hospital, was in existence approximately sixteen months. An enormous number of sick and wounded, said to be 18,000, was pa.s.sed through it with an infinitesimal death-rate, viz. four or five persons. Since the end of 1915, the No. 3 Australian General Hospital was moved from Mudros to the Barracks at Abba.s.sia, Cairo. The expenditure necessary to fit the barracks for the reception of No. 3 Australian General Hospital and the time taken are very interesting, since they show how utterly impossible any such arrangement would have been during the inrush of wounded in 1915. Stress is laid on the value of auxiliary hospitals as the only practicable means of surmounting difficulties at that time, in the report of the Committee of Inquiry into the Administration of the Australian Branch British Red Cross in Egypt.

Looking back at the practical conclusion of the work of the Australian Army Medical Corps in Egypt, it is quite evident that the policy originally adopted was the only one possible in the circ.u.mstances, and the results have fully justified it.

THE FLY CAMPAIGN

Very active steps were taken during 1916 in the direction of a campaign for the destruction of flies. The only addition that need be made to previous remarks is reference to the ingenious fly traps which have been devised. A large one was designed by Lt.-Col. Andrew Balfour, C.M.G., and is described in the journal of the Army Medical Corps of July 1916.

A modified form of this trap, furnished by the British Red Cross in Egypt, costs about 16_s._, and was most effective. These traps have been known to catch as many as 20,000 flies a day.

The smaller trap, which can be used indoors, and is made of zinc gauze, was made in large quant.i.ties by the British Red Cross Society in Alexandria, and distributed throughout Egypt.

Another kind of trap, a j.a.panese invention, with clockwork mechanism, manufactured by Owari Tokei, Kabushiki, Kwaisha, j.a.pan, has also been very successful. As many as 3,000 flies have been captured in one instance in an hour. It has a considerable advantage over the other traps in that its mechanism interests everyone.

Like all fly traps, however, the utility of these devices depends upon placing them in the hands of men whose business it is to see that they are properly baited and cared for, and on some ingenuity with regard to the baits. For the larger traps placed out-of-doors the best baits were found to be fishes' heads or the entrails of fowls, whilst the best bait for the smaller indoor trap was a mixture of beer or whisky and sugar.

It is, of course, quite evident that the destruction of flies by traps is not logically sound, since the proper method of control of the fly pest is by the destruction of all refuse; but as that is impracticable in Egypt, the traps were of great a.s.sistance.

In 1916 the fly pest as usual became marked during two periods in the year; viz. at the beginning and the end of summer. At the height of summer the dryness and desiccation evidently prevent the breeding of flies, a fact to be borne in mind in Australia.

The returns given in the House of Commons respecting the Gallipoli Campaign place the casualties at 116,000, and the cases invalided at 96,000. As a very large number of the cases of the sick were due to intestinal infections, some idea of the damage which may be caused by flies can be imagined.

The discovery of bilharzia eggs and the organisms of dysentery and diarrhoea in the faeces of flies made it clear that the fly plays an even larger part in disseminating disease than has. .h.i.therto been understood.

It really would appear that if the flies were destroyed infective diseases would fall to small proportions.

THE VENEREAL-DISEASE PROBLEM

The venereal-disease problem in the early part of 1916 gave very great concern, and active measures were taken to deal with it. In spite of all the ameliorating influences the problem reached its most serious phase in March and April 1916, as questions put in the House of Commons show (_vide_ _Lancet_, April 8, 1916). I think I express the conviction of certainly 90 per cent. of medical men in stating that nothing but education and educated prophylaxis will ever enable us to get rid of this source of destruction.

Y.M.C.A. AND RED CROSS

The Soldiers' Club in the Ezbekieh Garden grew in favour and was extended in area and staff. In the autumn of 1915 some ladies became available, and did splendid service in the superintendence of the catering for the men in the Club, and by their presence there did much to help.

A more extended experience of the work of the Y.M.C.A. and of the Red Cross has given much cause for thought. The Y.M.C.A. organisation appears to me to be excellent, since it is the organisation which caters for the social welfare of the soldier, wherever he may be, whether in camp or at the base; and the work is conducted by men whose business it is to understand him and see that all reasonable wants are gratified. In Egypt as I write (July 1916) there are no fewer than forty-seven Y.M.C.A. huts and centres, and Y.M.C.A. officers in the desert, in the oases, and elsewhere, doing their very best to make the soldiers comfortable. In other words, the business of the Y.M.C.A. is to provide comfort by personal service over and above military necessaries for the men who are well.

The Red Cross Society, on the other hand, attends to the wants of the sick and wounded, and its functions have already been discussed. They may, however, be supplemented by the following definition of the work of the Red Cross which was furnished by the High Commissioner for Egypt, Sir Henry MacMahon:

"Government supplies all the necessities for the care, treatment, and transport of the sick and wounded, while the Red Cross supplements these necessities by everything that can in any way go to the comfort and well-being of the sick and wounded soldiers. The distinction between necessities and comforts is sometimes so indefinite that the Red Cross, wherever possible, endeavours to have both ready to hand for use when needed."

And later: